Left Ventricular Torsional Mechanics in Uncomplicated Pregnancy

Background: Alterations in left ventricular (LV) twist (torsion) and untwist have been described for a variety of physiologic and pathologic conditions. Little information is available regarding changes in these parameters during normal pregnancy. Hypothesis: Pregnancy is associated with significant changes in LV torsional mechanics. Methods: Left ventricular twist and untwist was measured in 32 pregnant females (mean gestation 199 +/- 48 d) and 23 nonpregnant controls using speckle-tracking echocardiography. Results: Left ventricular ejection fraction (68 +/- 5% vs 66 +/- 5%) was similar between the groups (P not significant). There was a significant increase in peak LV twist from nonpregnant controls (9.4 +/- 3.7 degrees) to second-trimester (12.0 +/- 4.2 degrees) and third-trimester subjects (12.6 +/- 5.9 degrees, all P < 0.05). Peak LV twist velocity was also increased in second- and third-trimester groups compared with controls (94 +/- 24 degrees/sec and 93 +/- 30 vs 64 +/- 21 degrees/sec, respectively, both P < 0.05). Both peak untwist velocity and time to peak untwist velocity were not significantly different between groups (P not significant). Multiple regression ar alysis indicate that only systolic blood pressure (r = 0.394, P = 0.005) was an independent predictor for increased LV torsion. Conclusions: There are significant changes in LV torsional indices during the course of pregnancy, whereas untwist parameters remain unchanged. Blood pressure is independently associated with increased torsion during pregnancy.