Cardiovascular Adaptation in Normal Pregnancy With 2D and 3D Echocardiography, Speckle Tracking, and Radial Artery Tonometry.

BACKGROUND

Comprehensive cardiovascular assessment in normal pregnancy using advanced techniques has limited data.

OBJECTIVES

The aim of the study was to evaluate cardiovascular changes in normal pregnancy using two-dimensional/three-dimensional (3D) echo and applanation tonometry in healthy pregnant women.

METHODS

Two-dimensional/Doppler, speckle tracking strain, 3D echocardiography, and vascular compliance by applanation tonometry were performed during the first, second, and third trimesters and postpartum.

RESULTS

There were 45 healthy women (96% Hispanic) included. The heart rate increased in all trimesters 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,  < 0.001). A 3D left ventricular (LV) end systolic volume (34.583 ± 6.946 mL, 39.405 ± 7.345 mL, 45.994 ± 15.180 mL, 36.077 ± 7.116 mL), LV end diastolic volume (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 (30.690 ± 6.194 mL, 35.390 ± 7.345 mL, 40.929 ± 15.178 mL, 30.740 ± 6.911 mL), RV end diastolic volume (77.074 ± 14.875 mL, 86.871 ± 16.783 mL, 92.926 ± 18.083 mL, 78.267 ± 15.07 mL), and cardiac output increased ( < 0.01 for all) in the 2nd and 3rd trimester. LV longitudinal strain rate (SR) (-1.242 ± 0.350, -1.194 ± 0.181, -1.231 ± 0.263 vs -1.068 ± 0.218,  < 0.05) increased in all trimesters, RV longitudinal SR (-1.612 ± 0.314, -1.540 ± 0.284, -1.281 ± 0.748 vs -1.361 ± 0.306) in the 1st and 2nd trimester,  < 0.01), left atrial SR (1.735 ± 0.461, 1.687 ± 0.540, 1.588 ± 0.0.526 vs 1.414 ± 0.325), and right atrial SR (2.389 ± 0.582, 2.264 ± 0.741, 2.241 ± 0.793 vs 1.861 ± 0.600) in all trimesters, ( < 0.05). Left atrial volume increased in 2nd and 3rd trimesters, left atrial contraction velocity in 3rd trimester ( < 0.05), and pulmonary vein systolic filling velocity throughout pregnancy ( < 0.001). E/e' ratio did not change and LV ejection duration increased. Systolic augmentation of central aortic pressure decreased throughout.

CONCLUSIONS

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.