title: Structural and functional changes in maternal left ventricle during pregnancy: a three-dimensional speckle-tracking echocardiography study.
abstract: BACKGROUND
  Pregnancy represents a physiological adaptation to the transient load changes of maternal heart. This study aimed to investigate maternal left ventricle (LV) performance during normal pregnancy by three-dimensional speckle-tracking echocardiography (3D STE) parameters considering LV loading and shape.
  
  
  METHODS
  Sequential two-dimensional echocardiography (2DE) and 3D STE were performed on 68 women during each pregnancy trimester and 6 to 9 weeks after delivery, while thirty age-matched, healthy, nonpregnant women served as controls. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and global radial strain (GRS) were measured.
  
  
  RESULTS
  Increased cardiac index and progressive eccentric hypertrophy was detected, which subsequently recovered postpartum. In late pregnancy, GLS, GCS, GAS and GRS significantly decreased (P < 0.05) accompanied by a slight reduction of LV ejection fraction (EF) (P < 0.05), and these values returned postpartum to baseline level. All 3D strain indices correlated well with gestation age (P < 0.01), while compared to other components, GAS exhibited the strongest association with 3D EF (r = 0.549) and sphericity index (r = 0.328), and was the only parameter that correlated well with LV mass index (r = 0.22).
  
  
  CONCLUSIONS
  This study gives normal ranges of 3D STE indices in pregnancy. 3D STE demonstrated modified myocardial deformation and changes in maternal LV structure and function during the gestation period.
authors.affiliation: Department of Ultrasonic Diagnosis, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. congjuan0725@163.com.|Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. congjuan0725@163.com.|Henan Provincial Engineering Research Center for Perinatal Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. congjuan0725@163.com.|Henan Translational Medicine Engineering Laboratory for Maternal and Children's Health, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. congjuan0725@163.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Cong
authors.affiliation: Department of Ultrasonic Diagnosis, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. fan_tingpan@126.com.
authors.forename: Tingpan
authors.initials: T
authors.lastname: Fan
authors.affiliation: Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. yangxiaoqian1986@163.com.|Henan Provincial Engineering Research Center for Perinatal Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. yangxiaoqian1986@163.com.|Henan Translational Medicine Engineering Laboratory for Maternal and Children's Health, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. yangxiaoqian1986@163.com.
authors.forename: Xiaoqian
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Surgical Oncology, Massachusetts General Hospital, Boston, 02114, MA, USA. jwsquires@partners.org.
authors.forename: Jared Wynn
authors.initials: JW
authors.lastname: Squires
authors.affiliation: Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. 13803810939@126.com.|Henan Provincial Engineering Research Center for Perinatal Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. 13803810939@126.com.|Henan Translational Medicine Engineering Laboratory for Maternal and Children's Health, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. 13803810939@126.com.
authors.forename: Guomei
authors.initials: G
authors.lastname: Cheng
authors.affiliation: Henan Provincial Engineering Research Center for Perinatal Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. linlinzlynn@163.com.|Henan Translational Medicine Engineering Laboratory for Maternal and Children's Health, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. linlinzlynn@163.com.
authors.forename: Linlin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. zhangzhanzdsfy@126.com.|Henan Provincial Engineering Research Center for Perinatal Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. zhangzhanzdsfy@126.com.|Henan Translational Medicine Engineering Laboratory for Maternal and Children's Health, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China. zhangzhanzdsfy@126.com.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D000328:Adult; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D055119:Elastic Modulus / Q000502:physiology; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D015588:Observer Variation; D011247:Pregnancy / Q000502:physiology*; D011264:Pregnancy Trimesters / Q000502:physiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*