Left ventricular myocardial work in pregnant women with autoimmune diseases

Overview

This study quantitatively assessed left ventricular myocardial work parameters in pregnant women with autoimmune diseases using pressure-strain loop analysis and two-dimensional speckle-tracking echocardiography. The research compared three cohorts: pregnant women with autoimmune disease (AD-P, n=33), non-pregnant autoimmune disease patients (AD, n=26), and healthy pregnant women (H-P, n=37). The investigation aimed to identify subclinical left ventricular dysfunction and determine whether myocardial work indices provide diagnostic value beyond conventional strain imaging in this clinical population.

Methods and approach

Ninety-six participants were prospectively enrolled between September 2020 and September 2022. Clinical data collection included conventional echocardiography, two-dimensional speckle-tracking analysis, and left ventricular myocardial work quantification via pressure-strain loop methodology. Myocardial work parameters assessed included global work index, global constructive work, global work efficiency, apical constructive work, and peak strain dispersion. Statistical analysis employed analysis of covariance for adjusted group comparisons and partial correlation analysis to examine associations between baseline characteristics and myocardial work parameters, controlling for potential confounders.

Key Findings

Following adjustment for covariates, the AD-P group demonstrated increased left ventricular volumes and reduced apical constructive work relative to the AD group, while global myocardial work indices remained comparable. When compared with the H-P group, AD-P patients exhibited reduced mitral inflow E/A ratio, increased left ventricular volumes, elevated E/e', and increased peak strain dispersion. After adjustment, AD-P demonstrated significantly reduced global work index, global constructive work, global work efficiency, and apical constructive work, with persistently elevated peak strain dispersion. Apical constructive work reduction was identified as a consistent finding across AD-P comparisons.

Implications

The findings indicate that myocardial work analysis detected subclinical left ventricular dysfunction in pregnant women with autoimmune disease that was not fully apparent on conventional imaging parameters. The consistent reduction in apical constructive work across multiple comparisons suggests regional myocardial dysfunction localized to the ventricular apex in this population. These results support the potential clinical utility of myocardial work assessment as a complementary diagnostic tool in risk stratification and monitoring of pregnant patients with systemic autoimmune disease.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.