title: Changes in fetal left and right ventricular strain mechanics during normal pregnancy.
abstract: BACKGROUND
  The aim of this study was to detect normal changes in fetal two-dimensional speckle-tracking echocardiography-derived values for global and regional longitudinal left and right ventricular strain, strain rate, and time to peak (T2P) global strain during pregnancy.
  
  
  METHODS
  Forty-four healthy fetuses were examined prospectively during the second-trimester and third-trimester ultrasound examinations (20-24 and 30-34 weeks, respectively). Clips with high frame rates (mean, 120 frames/sec) of two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses of global and regional walls and segments (basal, mid, and apical) of myocardial strain and strain rate as well as T2P global strain in the longitudinal direction.
  
  
  RESULTS
  There were statistically significant decreases in global and regional strain of the right ventricle between the second and third trimesters. No statistically significant changes were observed in global and regional strain of the left ventricle. Global and regional strain rates of both ventricles decreased in a similar way during pregnancy. The mean T2P longitudinal left ventricular global strain (adjusted for heart rate) increased mildly during fetal life. Whereas T2P longitudinal strain of the left ventricle at 20 to 24 weeks was statistically significantly shorter than that of the right ventricle, no difference in T2P longitudinal strain was found at 30 to 34 weeks of gestation between both ventricles.
  
  
  CONCLUSIONS
  The establishment of these changes between the second-trimester and third-trimester two-dimensional speckle-tracking echocardiography-derived reference values is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.
authors.affiliation: Children's Heart Centre, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Pediatric Cardiology Unit, Edith Wolfson Medical Center, Holon, Israel. Electronic address: l.kapusta@cukz.umcn.nl.
authors.forename: Livia
authors.initials: L
authors.lastname: Kapusta
authors.affiliation: Pediatric Cardiology and Adults with Congenital Heart Disease, Rambam Medical Center, Haifa, Israel.
authors.forename: Gur
authors.initials: G
authors.lastname: Mainzer
authors.affiliation: Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
authors.forename: Zeev
authors.initials: Z
authors.lastname: Weiner
authors.affiliation: Biostatistical Consulting, BioStats, Modiin, Israel.
authors.forename: Lisa
authors.initials: L
authors.lastname: Deutsch
authors.affiliation: Pediatric Cardiology and Adults with Congenital Heart Disease, Rambam Medical Center, Haifa, Israel.
authors.forename: Asaad
authors.initials: A
authors.lastname: Khoury
authors.affiliation: Ultrasound Unit, Department of Obstetrics and Gynecology, Poria Baruch Pade Hospital, Tiberias, Israel.
authors.forename: Sami
authors.initials: S
authors.lastname: Haddad
authors.affiliation: Pediatric Cardiology and Adults with Congenital Heart Disease, Rambam Medical Center, Haifa, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Lorber
mesh_terms: D000328:Adult; D005260:Female; D005333:Fetus / Q000502:physiology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012016:Reference Values; D016216:Ultrasonography, Prenatal; D016276:Ventricular Function / Q000502:physiology*
keywords: 2D; 2D STE; AV; Atrioventricular valve; Fetal; IVS; Interventricular septum; LV; Left ventricular; Myocardial deformation; RV; Right ventricular; STE; Second-trimester ultrasound; Speckle-tracking echocardiography; Strain; T2P; Time to peak; Two-dimensional; Two-dimensional speckle-tracking echocardiography; VVI; Velocity Vector Imaging