Quantitative evaluation of longitudinal strain in layer-specific myocardium during normal pregnancy in China.
BACKGROUND
The myocardial wall of the left ventricle is a complex, multilayered structure and is not homogenous. The aim of this study was to determine longitudinal strain (LS) in the three myocardial layers in normal pregnant women according to gestation proceedings.


METHODS
The advanced two-dimensional speckle tracking echocardiography (2D STE) was performed on 62 women during each pregnancy trimester and 6 to 9 weeks after delivery, while 30 age-matched, healthy, nonpregnant women served as controls. LS on endocardial, mid-myocardial and epicardial layers at 18 cardiac segments were measured.


RESULTS
As gestation proceeded, all of layer-specific LS and global LS progressively decreased, which subsequently recovered postpartum (P < 0.05), and the LS gradient between inner and outer myocardium became greater, which reached its maximum in the late pregnancy. Peak systolic LS was the highest at endocardium and the lowest at epicardium, while the highest at the apical level and the lowest at the base (P < 0.05). In the early pregnancy and postpartum, LS at basal level was homogenous, meanwhile layer-specific LS showed significant differences at mid-ventricular and apical level throughout the progress of normal pregnancy (P < 0.05).


CONCLUSIONS
Using 2D STE, three-layer assessment of LS can be performed in pregnant women and shall give us new insights into the quantitative analysis of global and regional LV function during pregnancy. Future studies on the detection of pregnancy related heart disease would require these parameters as reference values for each time point of a normal pregnancy.
Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China. congjuanmd@126.com.
Juan
J
Cong
Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
Zhibin
Z
Wang
Department of Cardiology, The Affiliated Hospital of Shandong Medical College, Linyi, Shandong Province, China.
Hong
H
Jin
Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
Wugang
W
Wang
Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
Kun
K
Gong
Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
Yuanyuan
Y
Meng
Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
Yong
Y
Lee
D000328:Adult; D002681:China; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000379:methods*; D016277:Ventricular Function, Left; D055815:Young Adult
Layer; Myocardium; Pregnancy; Speckle-tracking; Strain