Livia Florentina TRASCA, Elena POENARU, Natalia PATRASCU, Ramona BRUJA, Octavian MUNTEANU, Monica CIRSTOIU and Dragos VINEREANU

ABSTRACT

Objectives: The impact of the gestational changes on left ventricular contractility is not clearly defined. Our aim was to evaluate the subtle changes of left ventricular systolic function during pregnancy, assessed by new echocardiographic techniques, in a population tested for inherited thrombophilia.
Material and methods: Eighty seven consecutive pregnant women, with a mean age of 32±4 years, genetically tested for inherited thrombophilia (22 with thrombophilic mutations and risk of thrombosis and 65 without significant mutations, considered as the control group) were included. All participants had four clinical and echocardiographyc visits: three during pregnancy (one in each trimester) and the forth six months after giving birth. Left ventricular (LV) systolic function was assessed from ejection fraction (EF) by 2D and 3D echocardiography, mitral annular velocities by tissue Doppler, and strain rate by 2D speckle tracking.
Outcomes: There were no differences between groups for any of the echo parameters at each of the four visits. Comparing the third visit with the first one, all parameters of LV systolic function had significantly lower values at the end of pregnancy; EF decreased from 58% to 55% (2D echo), from 60% to 56% (3D TomTec), and from 58% to 55% (Auto4DLVQ), with p<0.001 for all three methods. Moreover, strain assessed by speckle traking decreased during pregnancy, with no differences between groups. In addition to this, mitral annular velocities obtained by tissue Doppler assessment decreased during the gestational period, with no differences between groups. At six months after giving birth, all values were normalized.
Conclusion: During pregnancy, LV contractility has a slight decrease, with no criteria of systolic dysfunction. Thrombophilic mutations, with correct anticoagulant treatment, has no impact on LV systolic function.
Keywords: pregnancy, contractility, thrombophilia

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Maria-Claudia-Berenice SURAN, Andrei-Dumitru MARGULESCU, Ramona BRUJA, Calin SILISTE and Dragos VINEREANU

ABSTRACT

Background. Cardiac memory (CM) refers to persistent T-wave changes that appear after cessation of a period of abnormal ventricular activation, such as ventricular pacing. Prior animal studies using tagged magnetic resonance imaging have suggested that CM is associated with prolonged action potential duration and increased strain of late-activated myocardial segments.
Objective. The aim of the present study is to determine whether CM induced by ventricular pacing in human subjects is accompanied by regional mechanical changes in late-activated myocardial segments, assessed by left ventricular (LV) longitudinal strain (peak LS) and time-to-peak longitudinal strain (TTP-LS), using 2D-speckle tracking echocardiography (2DSE).
Material and methods. We included 20 patients (16 women, age 71±11 years), with DDD pacemakers and with normal AV conduction and QRS/T morphology at baseline. CM was induced by DDD pacing with a short AV delay. ECGs and 2DSE were performed before pacing (baseline), at peak CM (immediately after two weeks of pacing), and at CM washout (4 weeks after cessation of pacing). We measured by echocardiography: left ventricular (LV) ejection fraction, LV diastolic function (E, A, E/E’), peak LS and TTP-LS for the earliest (i.e. adjacent to the pacing site) and latest (i.e. latest-activated during ventricular pacing) segments, using an 18-segment LV model.
Results. All patients had electrical (ECG) CM changes, which disappeared by CM washout. LV global systolic and diastolic functions, as well as regional LS (peak LS for both the latest and earliest activated segments) were similar between evaluations. TTP for the latest and earliest activated segments, as well as mean TTP-LS, increased from baseline to peak CM, but did not decrease at CM washout. The dispersion of TTP-LS was not changed.
Conclusion. These results suggest that regional mechanical changes, as can be assessed by 2DSE longitudinal strain, do not overlap electrical CM.
Keywords: 2-dimensional strain, 2DSE, echocardiography, cardiac memory.

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