Left ventricular myocardial work in pregnant women with autoimmune diseases

To quantitatively assess left ventricular (LV) myocardial work (MW) in pregnant women with autoimmune diseases (AD) using left ventricular pressure-strain loop (PSL) and explore its clinical implications.

Ninety-six participants were enrolled between September 2020 and September 2022 at the Affiliated Hospital of Inner Mongolia Medical University, including 33 pregnant women with AD (AD-P group), 26 non-pregnant AD patients (AD group), and 37 healthy pregnant women (H-P group). Clinical data, conventional echocardiography, two-dimensional speckle-tracking, and LV-MW analyses were obtained. Group comparisons and correlations between baseline characteristics and MW parameters were analyzed. Analysis of covariance (ANCOVA) and partial correlation were used for adjusted comparisons and associations.

Following adjustment, the AD-P group demonstrated increased LV volume and lower apical constructive work (CW) compared to the AD group, while global MW indices were similar. Compared with H-P group, AD-P patients had lower E/A, increased LV volumes, E/e', and peak strain dispersion (PSD). After adjustment, AD-P had reduced global work index (GWI), global constructive work (GCW), global work efficiency (GWE), and apical-CW, while PSD remained higher.

LV myocardial work detected subclinical LV dysfunction in pregnant women with autoimmune disease. Apical-CW showed a consistent reduction in AD-P. These findings suggest that myocardial work, especially apical CW, provides incremental value over global longitudinal strain (GLS) in autoimmune pregnancies.