Dynamic change in maternal cardiac function during pregnancy

Area of Science:

• Cardiology
• Maternal-Fetal Medicine
• Echocardiography

Background:

• Physiological changes during pregnancy can lead to cardiac dysfunction and adverse outcomes.
• Left ventricular global longitudinal strain (LV-GLS) and P-wave to A' duration on tissue Doppler imaging (PA-TDI) are sensitive markers for subtle cardiac dysfunction.

Purpose of the Study:

• To investigate changes in cardiac structure and function throughout pregnancy.
• To evaluate the utility of LV-GLS and PA-TDI in detecting cardiac alterations during gestation.

Main Methods:

• Prospective cross-sectional study involving 506 healthy pregnant women and 172 nonpregnant controls.
• Participants were categorized into four groups: early pregnancy (T1), mid-pregnancy (T2), late pregnancy (T3), and nonpregnant controls (NPC).
• Echocardiographic parameters, including LV-GLS and PA-TDI, were analyzed, and multivariate regression was used to identify influencing factors.

Main Results:

• Left ventricular ejection fraction (LVEF) decreased in late pregnancy but remained within normal limits.
• Absolute LV-GLS values showed a gradual decrease with advancing gestational age (P < 0.001).
• PA-TDI duration was significantly longer in the third trimester compared to the first (P = 0.012) and second (P = 0.010) trimesters.
• Gestational age was independently associated with both LV-GLS (P = 0.027) and PA-TDI (P = 0.014).

Conclusions:

• Pregnancy is associated with a trend towards decreased left ventricular systolic and diastolic function.
• LV-GLS and PA-TDI are valuable tools for assessing subtle changes in cardiac function during pregnancy.