Evaluation Of Left Ventricular Function In Pregnant Women With Autoimmune Diseases By Non-Invasive Pressure-Strain Loop

Objective To quantitatively evaluate the left ventricular function in pregnant women with autoimmune disease（AD）non-invasive pressure-strain loop（PSL）and explore the clinical significance.Methods A total of 96 subjects were consecutively enrolled in this study in the Affiliated Hospital between September 2020 and September 2022,including 33 second trimester AD pregnant women as AD-P group who visited the rheumatology and immunology department,and 26 AD patients as AD group who visited the same period。What’s more,37 second trimester healthy pregnant women as H-P group who underwent routine pregnancy examination in obstetrics and gynecology department were also enrolled.Baseline clinical data such as age,gestational age,gestational history and blood pressure of all pregnant women were collected,as well as the duration of disease,laboratory examination and other disease-related data of subjects in AD-P group and AD group.Routine echocardiography was performed for all pregnant and non-pregnant subjects,and electrocardiogram was connected.Two-dimensional gravimetric dynamic images of long axis view of the left ventricle,three views of the left ventricular apex were collected for at least 3consecutive cardiac cycles.Echo PAC version 203（GE Vingmed Ultrasound AS）was used to analysis the offline images of all subjects.The left ventricular myocardium two-dimensional STI was used to obtain GLS and PSD.MW parameters were obtained by non-invasive PSL technique,Including left ventricular GWI and segmental MWI,GCW and segmental CW,GWW and segmental WW,GWE and segmental WE.The differences in two-dimensional myocardial strain and myocardial work between the two groups were compared,and the correlation between baseline clinical data and the parameters above of AD group were analyzed.Data were analyzed using the SPSS 25.0software.Data were analyzed using the SPSS 25.0 software.Shapiro-Wilk test was used to verify the normality of continuous variables.Continuous variables with normal distribution were expressed as mean±SD,and independent t-test was used for comparison between groups.Continuous variables with non-normal distribution were represented as median and interquartile range,and the Mann-Whitney U test was used for comparison between groups.Categorical variables were expressed as counts and proportions,and chi-square test or Fisher’s exact probability test was appropriately used for comparison between groups.Pearson and Spearman correlation analysis were used for univariate correlation analysis.Partial correlation analysis was used to identify the confounding factors which affect the correlation between strain parameters and clinical data.P<0.05 was considered statistically significant.Results 1.The number of anti-SSA/Ro antibody and anti-SSB/La antibody positive in AD-P group was significantly higher than that in AD group（all P<0.05）.The number of pregnant women with multiple pregnancies in AD-P group was significantly higher than that in H-P group（P<0.001）.2.LVEDV and LVESV in AD-P group were significantly higher than AD group（all P<0.05）;Compare with the H-P group,the left ventricular volume were significantly higher in AD-P group,while the mitral E/A was decreased and E/e’ratio was increased significantly in AD-P group;3.There was no significant difference in GLS and PSD between AD-P group and AD group;GLS in AD-P group were significantly lower than H-P group,while PSD was significantly increased.4.There was no significant difference in global MW parameters while CW in apical segment in AD-P group was significantly lower than that in AD group（P<0.05）;Compared with the H-P group,there was no significant difference in GWW,however,GWI,GCW and GWE in AD-P group were significantly decreased,while the MWI and CW in apical segment and CW in middle segment were also decreased significantly.5.The duration of disease in AD group was significantly positively correlated with GLS(r_s,GLS=0.361,P_GLS=0.020),and positive anti-SSA/Ro antibody was significantly positively correlated with PSD(r _PSD=0.416,P_PSD=0.016).What’s more,GLS was negatively correlated with GWI,GCW and GWE(r_s,GWI=-0.785,P_GWI<0.001;r_s,GCW=-0.621,P_GCW<0.001;r_s,GWE=-0.715,P_GWE<0.001),and positively correlated with GWW(r_s,GWW=0.384,P_GWW=0.027).PSD was negatively correlated with GWI and GWE(r_s,GWI=-0.400,P_GWI=0.021;r_s,GWE=-0.595,P_GWE<0.001)and were positively correlated with GWW(r_s,GWW=0.350,P_GWW=0.046).Multiple pregnancies history was positively correlated with GCW(r_s,GCW=0.408,P_GCW=0.018).The duration of disease was significantly negatively correlated with GWE(r_s,GWE=-0.510,P_GWE=0.002)and positively correlated with GWW(r_s,GWW=0.485,P_GWW=0.004).Conclusions Compared with healthy pregnant women,AD pregnant women have myocardial dysfunction and dyssynchrony.Compared with nonpregnant AD patients,pregnancy leads to myocardial damage in the apical segment.The duration of disease and anti-SSA/Ro antibody may be related to myocardial dysfunction and myocardial dyssynchrony,respectively.