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Usefulness of second trimester left ventricular global longitudinal strain for predicting adverse maternal outcome in pregnant women aged 35 years or older

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Abstract

The present study was primarily designed to accurately determine biventricular and biatrial myocardial function, assessed by two-dimensional speckle tracking echocardiography (2D-STE), in a prospective cohort of pregnant women aged ≥ 35 years, at the second trimester of pregnancy. Secondly, we aimed at investigating the main independent predictors of adverse maternal outcome (AMO) in the same study population. 80 consecutive pregnant women aged ≥ 35 years, 80 gestational week-matched (18.4 ± 1.6 vs 18.5 ± 1.8 weeks, p = 0.71) pregnant women aged < 35 years and 80 non-pregnant women aged ≥ 35 years without any comorbidity were included in this prospective study. All pregnant women underwent obstetric evaluation, modified Haller index (MHI) assessment and a conventional two-dimensional transthoracic echocardiography implemented with complete 2D-STE analysis of both ventricles and atria at the second trimester of pregnancy. AMO was defined as the occurrence of any of the following: gestational hypertension (GH) including preeclampsia; gestational diabetes mellitus (GDM); preterm delivery (PD); emergency caesarean section (ECS); postpartum haemorrhage (PPH); premature rupture of membranes (PROM); maternal death. Compared to younger pregnant women, pregnant women aged ≥ 35 years were more likely to be found with: (1) body mass index (BMI) ≥ 30 kg/m2 (37.5% of total); (2) significantly increased inflammatory markers; (3) significantly greater left ventricular mass index; (4) significantly impaired hemodynamics; (5) significantly reduced bi-atrial and bi-ventricular myocardial strain parameters, despite normal ejection fraction. A strong inverse correlation between second trimester BMI and left ventricular (LV)-global longitudinal strain (GLS) (r =  − 0.84) and between second trimester MHI and LV-GLS (r =  − 0.81) was demonstrated in pregnant women aged ≥ 35 years. GH, GDM, PD, ECS, PPH and PROM were detected in 15%, 12.5%, 10%, 8.7%, 8.7% and 7.5% of women, respectively. Age (OR 2.04, 95% CI 1.46–2.84), second trimester BMI (OR 2.40, 95% CI 1.64–3.51) and second trimester LV-GLS (OR 0.07, 95%C I 0.01–0.34) were independently associated with outcome. Age ≥ 37 years, BMI ≥ 30 kg/m2 and LV-GLS less negative than − 18% were the best cut-off values for predicting AMO. A LV-GLS less negative than − 18% allows to identify, among older pregnant women, those with an increased risk of AMO. Both intrinsic myocardial dysfunction and extrinsic compressive mechanical phenomena might affect global myocardial deformation during gestation.

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Abbreviations

2D:

Two-dimensional

A-P:

Antero-posterior

AUC:

Area under the curve

BMI:

Body mass index

BSA:

Body surface area

CI:

Confidence interval

DBP:

Diastolic blood pressure

EaI:

Arterial elastance index

EesI:

End-systolic elastance index

eGFR:

Estimated glomerular filtration rate

ESP:

End-systolic pressure

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

GSA+:

Positive global atrial strain

GSA−:

Negative global atrial strain

ICC:

Intraclass correlation coefficient

LA:

Left atrial

L-L:

Latero-lateral

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction.

LVESVi:

Left ventricular end-systolic volume index

LVMi:

Left ventricular mass index

LVOT:

Left ventricular outflow tract

MAP:

Mean arterial pressure

MAPSE:

Mitral annular plane systolic excursion

MHI:

Modified Haller index

NLR:

Neutrophil-to-lymphocyte ratio

OGTT:

Glucose tolerance test

RDW:

Red cell distribution width

ROC:

Receiver operating characteristics

RA:

Right atrial

RV:

Right ventricular

RWT:

Relative wall thickness

SBP:

Systolic blood pressure

SPAP:

Systolic pulmonary artery pressure

STE:

Speckle tracking echocardiography

SV:

Stroke volume

TAPSE:

Tricuspid annular plane systolic excursion

TGSA:

Total global atrial strain

TPR:

Total peripheral resistance

TTE:

Transthoracic echocardiography

VAC:

Ventricular-arterial coupling

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Acknowledgements

This work has been supported by Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica.

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Authors and Affiliations

  1. Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy

    Andrea Sonaglioni & Michele Lombardo

  2. Department of Cardiology, Policlinico San Giorgio, Pordenone, Italy

    Gian Luigi Nicolosi

  3. Department of Neonatology, IRCCS MultiMedica, Milan, Italy

    Claudio Migliori

  4. Department of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy

    Stefano Bianchi

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  1. Andrea Sonaglioni
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  2. Gian Luigi Nicolosi
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  3. Claudio Migliori
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  5. Michele Lombardo
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Contributions

AS: conceptualization; data curation; investigation; methodology; software; analysis; writing—original draft. GLN: conceptualization; supervision; validation; writing—review & editing. CM: conceptualization; supervision; validation; writing—review & editing. SB: conceptualization; supervision; validation; writing—review & editing. ML: conceptualization; supervision; validation; writing—review & editing.

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Correspondence to Andrea Sonaglioni.

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We wish to confirm that there are no conflicts of interest associated with this publication. Andrea Sonaglioni declares that he has no conflict of interest. Gian Luigi Nicolosi declares that he has no conflict of interest. Claudio Migliori declares that he has no conflict of interest. Stefano Bianchi declares that he has no conflict of interest. Michele Lombardo declares that he has no conflict of interest.

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All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Sonaglioni, A., Nicolosi, G.L., Migliori, C. et al. Usefulness of second trimester left ventricular global longitudinal strain for predicting adverse maternal outcome in pregnant women aged 35 years or older. Int J Cardiovasc Imaging 38, 1061–1075 (2022). https://doi.org/10.1007/s10554-021-02485-9

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