Objective: The aim of this study was to investigate longitudinal changes in biventricular diastolic function and myocardial deformation during pregnancy and the early postpartum period using tissue Doppler imaging (TDI), speckle-tracking echocardiography (STE), and rotational mechanics.
Method: In this prospective observational study, 65 healthy, normotensive women with singleton pregnancies underwent echocardiography at four standardized time points: first trimester (10-12 weeks), second trimester (20-24 weeks), third trimester (36-38 weeks), and early postpartum (6-12 weeks post-delivery). Comprehensive evaluation included conventional Doppler, TDI-derived parameters, longitudinal strain rates, atrial strain, and left ventricular (LV) twist mechanics.
Results: Pregnancy was characterized by a progressive rise in cardiac output and ventricular volumes, with parallel declines in diastolic indices and atrial function. Although LV ejection fraction remained preserved, early diastolic strain rate decreased by 19% (1.59→1.29 s-¹, P < 0.001), lateral Em velocity declined by 20%, and global LV twist was reduced by 20% (17.8°→14.2°, P = 0.002). The mitral E/A ratio progressively decreased, while deceleration time remained prolonged postpartum (203→243 ms, P < 0.001). Atrial strain analysis revealed chamber-specific remodeling: left atrial conduit strain showed near recovery, whereas right atrial parameters showed only partial normalization. Collectively, these findings indicate that diastolic and torsional mechanics did not fully normalize within 6-12 weeks, suggesting heterogeneous recovery trajectories even among healthy pregnancies.
Conclusion: In healthy women, pregnancy-induced myocardial adaptation appears to involve progressive diastolic and deformation changes that may persist into the early postpartum phase. The observation of residual subclinical alterations-despite otherwise physiological remodeling-suggests that longitudinal surveillance could be valuable, even in low-risk populations. Advanced echocardiographic modalities may improve early detection and contribute to refined risk stratification in pregnancy-related cardiac adaptation.