Abstract：
OBJECTIVE: By using conventional echocardiographic indices, cardiac pumping function remains unaltered during pregnancy. However, two-dimensional speckle tracking echocardiography (2D-STE) can detect subclinical changes of myocardial function even in patients with normal and stable left ventricular ejection fraction (LVEF).The aim of this study was to evaluate LV systolic performance during normal low risk pregnancy by using both conventional 2D and 3D echo indices and 2D-STE.
METHODS: One hundred and twelve pregnant women without any history of heart disease were prospectively recruited. They underwent serial echocardiographic evaluation in each pregnancy trimester and 6 months after delivery (time indicated as 1,2,3 and 4). 2D LVEF, 3D LVEF, LV global longitudinal strain (LVGLS), LV global circumferential strain (LVGCS) and LV-twist were measured and compared to the control group (c).
RESULTS: 2D-LVEF and 3D-LVEF were not significantly different among the three trimesters, postpartum and controls. LVGLS progressively decreased during pregnancy (1st :21.71 ± 2.13%, 2nd : 21.20 ± 2.30%, 3rd : 19.82 ± 2.10%, 4th : 21.81 ± 2.05%, c: 21.71 ± 2.2%, overall p < 0,001) which receded during puerperium. No significant difference was noted in LVGCS (1st : 18.08 ± 5.54%, 2nd : 18.57 ± 3.41%, 3rd :18.20 ± 3.33%, 4th : 17.95 ± 3.39%, c: 18.8 ± 2.2%, p > 0.3). LV-Twist was significantly higher in the 1st trimester compared to controls (p = 0.04) and remained constantly high during the rest of the pregnancy and puerperium (1st :13.80 ± 5.09°, 2nd :13.46 ± 5.35°, 3rd :13.58 ± 4.32°, 4th :13.37 ± 4.26°, c: 11.5 ± 4.3°).
CONCLUSIONS: In low risk individuals with normal pregnancy, a redistribution of force occurs especially in the 3rd trimester. Longitudinal strain decreases, while torsional movement of the heart increases and counterbalances the temporal change of longitudinal systolic function. These changes would probably reflect the pathophysiological alterations related to pregnancy.
METHODS: One hundred and twelve pregnant women without any history of heart disease were prospectively recruited. They underwent serial echocardiographic evaluation in each pregnancy trimester and 6 months after delivery (time indicated as 1,2,3 and 4). 2D LVEF, 3D LVEF, LV global longitudinal strain (LVGLS), LV global circumferential strain (LVGCS) and LV-twist were measured and compared to the control group (c).
RESULTS: 2D-LVEF and 3D-LVEF were not significantly different among the three trimesters, postpartum and controls. LVGLS progressively decreased during pregnancy (1st :21.71 ± 2.13%, 2nd : 21.20 ± 2.30%, 3rd : 19.82 ± 2.10%, 4th : 21.81 ± 2.05%, c: 21.71 ± 2.2%, overall p < 0,001) which receded during puerperium. No significant difference was noted in LVGCS (1st : 18.08 ± 5.54%, 2nd : 18.57 ± 3.41%, 3rd :18.20 ± 3.33%, 4th : 17.95 ± 3.39%, c: 18.8 ± 2.2%, p > 0.3). LV-Twist was significantly higher in the 1st trimester compared to controls (p = 0.04) and remained constantly high during the rest of the pregnancy and puerperium (1st :13.80 ± 5.09°, 2nd :13.46 ± 5.35°, 3rd :13.58 ± 4.32°, 4th :13.37 ± 4.26°, c: 11.5 ± 4.3°).
CONCLUSIONS: In low risk individuals with normal pregnancy, a redistribution of force occurs especially in the 3rd trimester. Longitudinal strain decreases, while torsional movement of the heart increases and counterbalances the temporal change of longitudinal systolic function. These changes would probably reflect the pathophysiological alterations related to pregnancy.
摘要：
目的：通过使用常规超声心动图指标，心脏泵功能在怀孕期间保持不变。然而,二维斑点追踪超声心动图（2D-STE）可以检测左心室射血分数（LVEF）正常和稳定的患者心肌功能的亚临床变化。这项研究的目的是通过使用常规的2D和3D回声指数以及2D-STE来评估正常低危妊娠期间的LV收缩性能。
方法：前瞻性招募了112名没有任何心脏病史的孕妇。他们在每个妊娠三个月和分娩后6个月（时间分别为1、2、3和4）进行了连续超声心动图评估。2DLVEF,3DLVEF,低压全球纵向应变(LVGLS),测量LV整体周向应变(LVGCS)和LV扭曲,并与对照组(c)进行比较。
结果：2D-LVEF和3D-LVEF在三个孕期没有显着差异，产后和控制。LVGLS在怀孕期间逐渐降低（第1位：21.71±2.13％，第二名：21.20±2.30%，第三名：19.82±2.10%，第四：21.81±2.05%，c:21.71±2.2%,总体p<0,001)，在产褥期消退。LVGCS无明显差异（第1位：18.08±5.54％，第二名：18.57±3.41%，第三名：18.20±3.33%，第四：17.95±3.39%，c:18.8±2.2%,p>0.3)。与对照组相比，妊娠前三个月的LV-Twist显着升高（p=0.04），并且在妊娠和产褥期的其余时间一直保持较高（第1位：13.80±5.09°，第二：13.46±5.35°，第三名:13.58±4.32°,第四：13.37±4.26°，c:11.5±4.3°)。
结论：在正常妊娠的低风险个体中，力的重新分配尤其发生在妊娠晚期。纵向应变减小,而心脏的扭转运动增加并抵消了纵向收缩功能的时间变化。这些变化可能反映了与妊娠相关的病理生理改变。
方法：前瞻性招募了112名没有任何心脏病史的孕妇。他们在每个妊娠三个月和分娩后6个月（时间分别为1、2、3和4）进行了连续超声心动图评估。2DLVEF,3DLVEF,低压全球纵向应变(LVGLS),测量LV整体周向应变(LVGCS)和LV扭曲,并与对照组(c)进行比较。
结果：2D-LVEF和3D-LVEF在三个孕期没有显着差异，产后和控制。LVGLS在怀孕期间逐渐降低（第1位：21.71±2.13％，第二名：21.20±2.30%，第三名：19.82±2.10%，第四：21.81±2.05%，c:21.71±2.2%,总体p<0,001)，在产褥期消退。LVGCS无明显差异（第1位：18.08±5.54％，第二名：18.57±3.41%，第三名：18.20±3.33%，第四：17.95±3.39%，c:18.8±2.2%,p>0.3)。与对照组相比，妊娠前三个月的LV-Twist显着升高（p=0.04），并且在妊娠和产褥期的其余时间一直保持较高（第1位：13.80±5.09°，第二：13.46±5.35°，第三名:13.58±4.32°,第四：13.37±4.26°，c:11.5±4.3°)。
结论：在正常妊娠的低风险个体中，力的重新分配尤其发生在妊娠晚期。纵向应变减小,而心脏的扭转运动增加并抵消了纵向收缩功能的时间变化。这些变化可能反映了与妊娠相关的病理生理改变。
