Left ventricular rotational characteristics in healthy mid-term pregnancy—insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Preg Study

Background: Haemodynamic, neurohormonal, plasma volume, haematological, and structural cardiac changes occur during healthy pregnancy to varying degrees depending on the trimester. The aim of the present observational cross-sectional study was to compare left ventricle (LV) rotational mechanics in healthy pregnant subjects with those of age-matched non-pregnant women using three-dimensional speckle-tracking echocardiography (3DSTE). Methods: The initial study population consisted of 27 healthy subjects in mid-term pregnancy; however, 6 cases were excluded due to suboptimal image quality. Consequently, the final analytical cohort comprised 21 subjects (mean age: 30.7±2.7 years). This group was compared to a control group of 27 age-matched healthy non-pregnant volunteers (mean age: 28.4±6.0 years). Results: In three pregnant subjects, the near absence of LV rotational mechanics, referred to as rigid body rotation (RBR), was observed (3 of 21, 14%) with counterclockwise orientation. The remaining 18 subjects showed normally directed LV rotational mechanics (18 of 21, 86%). A significant reduction in apical LV rotation (4.0±3.9° vs. 9.2±3.2°, P<0.05) and LV twist (6.8±3.6° vs. 13.1±3.4°, P<0.05) could be detected in healthy pregnant women compared with non-pregnant subjects. Basal LV rotation did not differ significantly between the two groups (−3.2±2.3° vs. −3.8±1.8°, P=ns). Time to peak apical LV twist tended to be shorter in pregnant women; however, this difference did not reach statistical significance. Conclusions: Reduced apical LV rotation and consequent LV twist with preserved basal LV rotation could be detected in healthy mid-term pregnancy. In some cases, counterclockwise LV-RBR was observed.