Cardiac Adaptation of the Maternal Heart During Pregnancy: A Color-Coded Tissue Doppler Imaging Study – Feasibility, Reproducibility and Course during Pregnancy

Abstract

Purpose: Tissue Doppler imaging (TDI) allows the noninvasive quantification of global and regional myocardial function. Since there are changing loading conditions during pregnancy, this study aimed to determine maternal myocardial adaptation in normal pregnancy with TDI and tracking of the heart cycle.

Patients and Methods: 106 pregnant women, mean age of 33.4 years at baseline, prospectively underwent a total of 161 color-coded tissue Doppler echocardiography samples throughout pregnancy. In further offline analysis of the global and regional myocardial function of the basal segments, maximum tissue velocities at systole (Sm), in the early filling phase of diastole (Em) and during atrial contraction (Am) were assessed.

Results: From those stored samples, S-wave, E-wave and A-wave velocities could be obtained with a feasibility of 94.8 % and with good inter- and intra-observer variability. S-wave velocity first showed an increase during early pregnancy followed by a decline to baseline characteristics at the 3 rd trimester. The E-wave velocity declined throughout pregnancy. The A-wave velocity increased continuously. These alterations result in a continuous decline of Em/Am ratio as pregnancy advances.

Conclusion: Alterations in tissue velocities during pregnancy reflect maturational changes that mimic “diastolic dysfunction”. Based on an understanding of those normal physiological changes, TDI may therefore assist in the monitoring and/or detecting of subclinical myocardial dysfunction during pregnancy.

Zusammenfassung

Ziel: Gewebsdoppler erlauben eine nicht-invasive Quantifizierung der globalen und regionalen Herzfunktion. Während der Schwangerschaft ändern sich die hämodynamischen Bedingungen des Herzens. Diese Studie untersuchte dabei die mütterliche Adaption des Herzens mittels Gewebsdoppel-Echokardiografie während einer normalen Schwangerschaft unter Berücksichtigung des Herzzyklus mit der „Tracking“ Methode.

Patienten und Methoden: 106 schwangere Frauen (Alter 33,4 Jahre bei der Eingangsuntersuchung) nahmen an der prospektiven Untersuchung teil. Insgesamt wurden dabei 161 farbcodierte Gewebsdoppel über den kompletten Schwangerschaftszeitraum aufgenommen. In der nachgeschalteten Analyse der globalen und regionalen Herzfunktion des basalen Abschnitts wurden die Geschwindigkeiten des Myokards in der Systole (Sm), in der frühen Füllphase der Diastole (Em) und während der atrialen Kontraktion bemessen (Am).

Ergebnisse: Von den aufgezeichneten Untersuchungen konnte die S-, E- und A-Welle in 94,8 % der Fälle sowohl mit guter interner, als auch externer Untersuchervariabilität ermittelt werden. Die Geschwindigkeit der S-Welle zeigte zuerst einen Anstieg, gefolgt von einem Rückgang der Geschwindigkeit im dritten Trimester. Die Geschwindigkeit der E-Welle nahm während der ganzen Schwangerschaft ab während die Geschwindigkeit der A-Welle stetig zunahm. Diese Veränderung resultierte in eine Abnahme des Em-/Am-Verhältnisses während der Schwangerschaft.

Schlussfolgerung: Die Veränderung der Gewebsgeschwindigkeiten des mütterlichen Herzens spiegeln Veränderungen wieder, welche eine diastolische Dysfunktion imitieren. Mit diesem Verständnis der physiologischen Adaption während der Schwangerschaft können die Gewebsdoppler dafür benutzt werden eine subklinische Dysfunktion des mütterlichen Herzens während der Schwangerschaft zu entdecken oder zu überwachen.

Key words

tissue Doppler - tracking method - pregnant - mother's heart

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