Gestational changes in left ventricular myocardial contractile function: new insights from two-dimensional speckle tracking echocardiography

  • Shantanu P. Sengupta
  • Manish Bansal
  • Leonard Hofstra
  • Partho P. Sengupta
  • Jagat Narula
Original Paper


The goal of this study was to evaluate the impact of pregnancy and labor on left ventricular (LV) myocardial mechanics using speckle tracking echocardiography (STE). Pregnancy is characterized by profound hormonal and hemodynamic alterations that directly or indirectly influence cardiac structure and function. However, the impact of these changes on left ventricular (LV) myocardial contractile function has not been fully elucidated. In this prospective, longitudinal study, 35 pregnant women underwent serial clinical and echocardiographic evaluation during each trimester and at labor. Two dimensional STE was performed to measure global LV longitudinal, circumferential and radial strain (GLS, GCS and GRS, respectively). Similar data obtained from 20 nulliparous, age-matched women were used as control. All strain values during pregnancy were adjusted for age and hemodynamic parameters. There was a progressive increase in heart rate, systolic and diastolic blood pressure, cardiac output and LV stroke-work during pregnancy. LV end-diastolic and end-systolic volumes also increased progressively but LV ejection fraction remained unaltered, except for slight reduction during the second trimester. Compared to the controls, GLS and GCS were reduced in the first trimester itself (GLS −22.39 ± 5.43 % vs. −18.66 ± 0.64 %, P 0.0002; GCS −20.84 ± 3.20 vs. −17.88 ± 0.09, P < 0.001) and remained so throughout the pregnancy and labor. In contrast, GRS showed an increase during pregnancy which peaked during the second trimester (24.18 ± 0.39 % vs. 18.06 ± 8.14 % in controls, P < 0.001). Alterations in loading conditions during pregnancy are associated with counterbalancing changes in the myocardial mechanics. LV longitudinal and circumferential strain are reduced whereas radial strain is increased. These counterbalancing changes serve to maintain overall LV ejection performance within a normal range and enable the maternal heart to meet the hemodynamic demands of pregnancy and labor.


Left ventricular function Speckle tracking echocardiography Myocardial deformation Pregnancy 



Mitral inflow late diastolic velocity


Blood pressure


Circumferential strain


Mitral inflow early diastolic velocity


Early diastolic mitral annular velocity


End-diastolic volume


Ejection fraction


End-systolic volume


Global circumferential strain


Global longitudinal strain


Global radial strain


Left atrial


Left atrial volume


Longitudinal strain


Left ventricular


Radial strain


Speckle tracking echocardiography


Compliance with ethical standards

Conflict of interest

There is no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study and the study was approved by the institutional ethics committee.


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Shantanu P. Sengupta
    • 1
  • Manish Bansal
    • 2
  • Leonard Hofstra
    • 3
  • Partho P. Sengupta
    • 4
  • Jagat Narula
    • 4
  1. 1.Sengupta Hospital and Research InstituteNagpurIndia
  2. 2.Medanta-The MedicityGurgaonIndia
  3. 3.Cardiology CentreUtrechtThe Netherlands
  4. 4.Mount Sinai School of MedicineNew YorkUSA

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