Cardiovascular Adaptation in Normal Pregnancy With 2D and 3D Echocardiography, Speckle Tracking, and Radial Artery Tonometry
Authors' conclusion
Increased contractility of all four cardiac chambers, LV ejection-duration, and reduced LV afterload provide efficient cardiovascular adaptation despite increased chamber volumes and heart rate during normal pregnancy.
Study context
- Population
- Healthy pregnant women (96% Hispanic)
- Participants
- 45 women
- Exposure
- 1st, 2nd and 3rd trimesters vs postpartum
- Outcome
- Cardiovascular changes across pregnancy (1st, 2nd, 3rd trimester vs postpartum)
- Follow-up
- 1st, 2nd and 3rd trimesters and postpartum
Methodological details2D/Doppler, speckle tracking strain, 3D echo and applanation tonometry in 1st, 2nd and 3rd trimesters and postpartum
- 2D/Doppler, speckle tracking strain, 3D echo and applanation tonometry in 1st, 2nd and 3rd trimesters and postpartum
Main finding
As reported in the abstract
- Heart rate increased in all trimesters vs postpartum (T1, T2, T3 vs postpartum)
- 70.538 ± 9.208 beats/min, 74.878 ± 8.094 beats/min, 74.107 ± 9.231 beats/min vs 61.613 ± 9.790 beats/min, P < 0.001
- 3D left ventricular (LV) end systolic volume (T1, T2, T3, postpartum); increased in 2nd and 3rd trimester
- 34.583 ± 6.946 mL, 39.405 ± 7.345 mL, 45.994 ± 15.180 mL, 36.077 ± 7.116 mL
- LV end diastolic volume (T1, T2, T3, postpartum); increased in 2nd and 3rd trimester
- 83.672 ± 14.022 mL, 91.512 ± 14.602 mL, 97.581 ± 19.864 mL, 85.163 ± 13.960 mL
- Right ventricular (RV) end systolic volume (T1, T2, T3, postpartum); increased in 2nd and 3rd trimester
- 30.690 ± 6.194 mL, 35.390 ± 7.345 mL, 40.929 ± 15.178 mL, 30.740 ± 6.911 mL
- RV end diastolic volume (T1, T2, T3, postpartum); increased in 2nd and 3rd trimester
- 77.074 ± 14.875 mL, 86.871 ± 16.783 mL, 92.926 ± 18.083 mL, 78.267 ± 15.07 mL
- Volumes and cardiac output increased in 2nd and 3rd trimester
- P < 0.01 for all
- LV longitudinal strain rate (SR) increased in all trimesters (T1, T2, T3 vs postpartum)
- −1.242 ± 0.350, −1.194 ± 0.181, −1.231 ± 0.263 vs −1.068 ± 0.218, P < 0.05
- RV longitudinal SR increased in 1st and 2nd trimester (T1, T2, T3 vs postpartum; P < 0.01)
- −1.612 ± 0.314, −1.540 ± 0.284, −1.281 ± 0.748 vs −1.361 ± 0.306
- Left atrial SR increased in all trimesters
- P < 0.05
- Right atrial SR increased in all trimesters (T1, T2, T3 vs postpartum; P < 0.05)
- 2.389 ± 0.582, 2.264 ± 0.741, 2.241 ± 0.793 vs 1.861 ± 0.600
- Left atrial volume increased in 2nd and 3rd trimesters; left atrial contraction velocity in 3rd trimester
- P < 0.05
- Pulmonary vein systolic filling velocity increased throughout pregnancy
- P < 0.001
Observational data: associations, not effects.
Further findings
Left atrial volume, left atrial contraction velocity, pulmonary vein systolic filling velocity
- Left atrial volume increased in 2nd and 3rd trimesters, left atrial contraction velocity in 3rd trimester
- P < 0.05
- Pulmonary vein systolic filling velocity increased throughout pregnancy
- P < 0.001
E/e' ratio, LV ejection duration, central aortic systolic augmentation
- E/e' ratio did not change
- LV ejection duration increased
- Systolic augmentation of central aortic pressure decreased throughout
Original publication
Cardiovascular Adaptation in Normal Pregnancy With 2D and 3D Echocardiography, Speckle Tracking, and Radial Artery Tonometry. JACC Adv. Published 7 November 2024. doi:10.
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