Myocardial tissue characterization and strain analysis in healthy pregnant women using cardiovascular magnetic resonance native T1 mapping and feature tracking technique

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Abstract

Background

Peripartum cardiomyopathy is a life-threatening condition that occurs during the peripartum period in previously healthy women. Cardiovascular magnetic resonance (CMR) T1 mapping permits sensitive detection of tissue edema and fibrosis, and it may be useful in identifying altered myocardial tissue characteristics in peripartum cardiomyopathy. However, left ventricular (LV) volumes and mass increase considerably even in normal pregnancy, and it is not known whether altered tissue characteristics can be found in normal pregnancy. The aim of this study was to investigate whether the LV remodeling observed in normal pregnancy is associated with altered tissue characteristics determined by CMR.

Methods

Twelve normal pregnant women and 15 non pregnant women underwent cine CMR and myocardial T1 measurement at 1.5 T. Pregnant women were scanned three times, in the 2nd and 3rd trimesters of pregnancy and at 1 month postpartum. LV volumes, LV mass (LVM), and global longitudinal strain (GLS) were analyzed by cine CMR. Native myocardial T1 was determined using modified Look-Locker inversion recovery (MOLLI) images.

Results

LV end-diastolic volume (EDV) was significantly greater in the 3rd trimester (126 ± 22 mL) than in non-pregnant women (108 ± 14 mL, p < 0.05). LVM was significantly greater in the 3rd trimester (88.7 ± 11.8 g) than at 1 month postpartum (70.0 ± 9.8 g, p < 0.05) and in non-pregnant women (66.3 ± 13.9 g, p < 0.05). Myocardial native T1 among the 2nd and 3rd trimesters, 1 month postpartum, and non-pregnant women were similar (1133 ± 55 ms, 1138 ± 86 ms, 1105 ± 45 ms, and 1129 ± 52 ms, respectively, p = 0.59) as were GLS (− 19.5 ± 1.8, − 19.7% ± 2.2, − 19.0% ± 2.0%, and − 19.3% ± 1.9%, respectively, p = 0.66).

Conclusions

LV remodeling during normal pregnancy is associated with myocardial hypertrophy, but not with edema or diffuse fibrosis of the myocardium or LV contractile dysfunction. These results observed in normal pregnancy will serve as an important basis for identifying myocardial abnormalities in patients with peripartum cardiomyopathy and other pregnancy-related myocardial diseases.

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Most cited references 28

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Stephanie N. Sass, Y. Parag, C E Kühni … (2007)

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Maternal Cardiovascular Function in Normal Pregnancy: Evidence of Maladaptation to Chronic Volume Overload.

Karen Melchiorre, Rajan Sharma, Asma Khalil … (2016)

The aim of this study was to investigate cardiac functional status in pregnancy using a comprehensive approach taking into account the simultaneous changes in loading and geometry, as well as maternal age and anthropometric indices. This was a prospective cross-sectional study of 559 nulliparous pregnant women assessed at 4 time points during pregnancy and at 1 year postpartum. All women underwent conventional echocardiography and tissue Doppler velocities and strain rate analysis at multiple cardiac sites. Mean arterial pressure and total vascular resistance index significantly decreased (both P<0.001) during the first 2 trimesters of pregnancy and increased thereafter. Stroke volume index and cardiac index showed the opposite trend compared with mean arterial pressure and total vascular resistance index (both P<0.05). Myocardial and ventricular function were significantly enhanced in the first 2 trimesters but progressively declined thereafter. By the end of pregnancy, significant chamber diastolic dysfunction and impaired myocardial relaxation was evident in 17.9% and 28.4% of women, respectively, whereas myocardial contractility was preserved. There was full recovery of cardiac function at 1 year postpartum. Cardiovascular changes during pregnancy are thought to represent a physiological adaptation to volume overload. The findings of a drop in stroke volume index, impaired myocardial relaxation with diastolic dysfunction, and a tendency toward eccentric remodeling in a significant proportion of cases at term are suggestive of cardiovascular maladaptation to the volume-overloaded state in some apparently normal pregnancies. These unexpected cardiovascular findings have important implications for the management of both normal and pathological pregnancy states.

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Morphological and functional adaptation of the maternal heart during pregnancy.

Sorin Giusca, Frank E Rademakers, Jan Deprest … (2012)

Pregnancy provides a unique model to study the adaptation of the heart in a physiological situation of transient load changes. The aim of this study was to assess the performance of the left ventricle (LV) in normal, uncomplicated pregnancies while considering the actual LV load and shape. Serial echocardiographic examinations were performed in 51 women in each pregnancy trimester and 3 to 6 months after delivery. Data from 10 nulliparous, age-matched women were used as the control. Conventional parameters of LV function (ejection fraction) as well as myocardial deformation (strain) were interpreted, taking into consideration maternal hemodynamics and LV shape. Cardiac output increased during pregnancy because of a higher stroke volume in early pregnancy and a late increase in heart rate, whereas total vascular resistance decreased. Progressive development of eccentric hypertrophy was observed, which subsequently recovered postpartum. Sphericity index decreased from the first to the third trimester (1.92±0.17 versus 1.71±0.17) and returned postpartum to values comparable to the control. Although higher LV stroke work was noted toward the third trimester (5.9±1.1 versus 5.3±1.0 Newton meter, P<0.001), ejection fraction showed no significant changes. LV strain decreased significantly in late pregnancy (-19.5±2% to -17.6±1.6%, P<0.001) and returned to baseline values after delivery (-19.5±2%). Pregnancy is a physiological process associated with increased cardiac performance and progressive LV remodeling. These changes are not directly reflected by parameters traditionally considered to describe systolic function, such as ejection fraction and longitudinal deformation. While ejection fraction was insensitive to the functional changes, the transient decrease in longitudinal deformation becomes only plausible when considering the changes in LV geometry.

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Author and article information

Contributors

Masafumi Nii: doaldosleeping@yahoo.co.jp

Masaki Ishida: ishidamasaki1@gmail.com

Kaoru Dohi: dohik@clin.medic.mie-u.ac.jp

Hiroaki Tanaka: h_tanaka@med.miyazaki-u.ac.jp

Eiji Kondo: eijikon@clin.medic.mie-u.ac.jp

Masaaki Ito: mitoka@clin.medic.mie-u.ac.jp

Hajime Sakuma: sakuma.mie@gmail.com

Tomoaki Ikeda: t-ikeda@clin.medic.mie-u.ac.jp

Journal

Journal ID (nlm-ta): J Cardiovasc Magn Reson

Journal ID (iso-abbrev): J Cardiovasc Magn Reson

Title: Journal of Cardiovascular Magnetic Resonance

Publisher: BioMed Central (London )

ISSN (Print): 1097-6647

ISSN (Electronic): 1532-429X

Publication date (Electronic): 2 August 2018

Publication date PMC-release: 2 August 2018

Publication date Collection: 2018

Volume: 20

Electronic Location Identifier: 52

Affiliations

[1 ]ISNI 0000 0004 1769 2015, GRID grid.412075.5, Department of Obstetrics and Gynecology, , Mie University Hospital, ; 2-174 Edobashi, Tsu, Mie 514-8507 Japan

[2 ]ISNI 0000 0004 1769 2015, GRID grid.412075.5, Department of Radiology, , Mie University Hospital, ; 2-174 Edobashi, Tsu, Mie 514-8507 Japan

[3 ]ISNI 0000 0004 1769 2015, GRID grid.412075.5, Department of Cardiology and Nephrology, , Mie University Hospital, ; 2-174 Edobashi, Tsu, Mie 514-8507 Japan

Article

Publisher ID: 476

DOI: 10.1186/s12968-018-0476-5

PMC ID: 6090929

PubMed ID: 30068369

SO-VID: 7bdf6621-5004-43f6-8f4c-78a93570ad52

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 8 January 2018

Date accepted : 19 July 2018

Custom metadata

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: cardiovascular magnetic resonance,cardiac function,native myocardial t1 mapping,pregnancy,myocyte mass,peripartum cardiomyopathy

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: cardiovascular magnetic resonance, cardiac function, native myocardial t1 mapping, pregnancy, myocyte mass, peripartum cardiomyopathy

Myocardial tissue characterization and strain analysis in healthy pregnant women using cardiovascular magnetic resonance native T1 mapping and feature tracking technique

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Karger: Cardiovascular System

Most cited references 28

ACR guidance document for safe MR practices: 2007.

Maternal Cardiovascular Function in Normal Pregnancy: Evidence of Maladaptation to Chronic Volume Overload.

Morphological and functional adaptation of the maternal heart during pregnancy.

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