Changes in Left and Right Ventricular Longitudinal Strain During Normal Pregnancy

Pregnancy is known to be associated with several physiological adaptations affecting the cardiovascular system. The aim of this study was to describe the normal gestational changes in left ventricular (LV) and right ventricular (RV) longitudinal strain (LS).

This was a prospective longitudinal single center study including 60 healthy pregnant females, without history of any medical condition, structural heart disease, cardiovascular risk factors or pregnancy-related complication. A baseline echocardiographic study was performed during the first half second trimester (16-20 weeks) with follow-up near the end of the third trimester (32-36 weeks).

The mean age of the study population was 24.8 ± 5 years. There was an increase in LV end-diastolic and end-systolic volumes: from 92.7 ± 7.2 to 107.2 ± 9.2 mL and from 40.9 ± 6.3 to 48.1 ± 7.2 mL (p < 0.001), respectively. RV basal diameter also increased from 33.9 ± 2.3 to 36.5 ± 2.0 mm (p < 0.001). On the other hand, the absolute value of LV global LS decreased from -22.4 ± 2.2 to -20.0 ± 1.7 % (p < 0.001), an 11% change; and RV free wall LS from -28.7 ± 4.1 to -24.7 ± 3.3 % (p < 0.001), a 14% change.

LV and RV longitudinal strain decreased significantly during normal pregnancy at the end of the third trimester as compared to the beginning of the second trimester. This may suggest that a trimester-specific reference range of strain may need to be considered.