Evaluation Of Left Cardiac Function In Healthy Pregnant Women Using Full Volume Three-Dimensional Echocardiography

Objective: Prominent adaptable changes of structure, function and hemodynamics have taken place in normal pregnant women's cardiovascular system. Because of its characteristics of convenience, noninvasion, accuratissime, cheap and strong repetitiveness, echocardiography became one of the important means of detecting maternal cardiac function by clinic from the later stage of the seventies. There were a large number of researches evaluating cardiac structure, systolic and diastole function using conventional ME, 2DE and doppler echocardiography. RT-3DE is a great technological break-through in the field of cardiac ultrasonic imaging for the past few years. Full volume imaging is one mode of RT-3DE.But the report of evaluating normal pregnant women's cardiac function by full volume imaging is rare now. The study was designed to investigate the value of the early quantitation in healthy pregnant women's left cardiac function using new technique FV-3DE.Methods: The left heart of 52 healthy pregnant women (15 first trimester, 18 second trimester and 19 third trimester ) and 20 age matching healthy nonpregnant women(control group) were detected by FV-3DE and conventional echocardiography. The left cardiac parameters of healthy pregnant women group and control group were compared and analyzed.They were:left atrial function (LAVmax, LAVmin, LAEF, LASV), left ventricular mass (LVM, LVMI), left ventricular function (LVEDV, LVESV, LVSV, LVEF, LVCO, LVCI, PER, PFR); left cardiac structure and function (LVEDd, IVSd, LVPWd, LAs; E, A and E/A ).Meanwhile, the hemodynamic indexes (MBP,TPR) were analyzed . Results: The imaging satisfactory rates of FV-3DE were 100%(the control group and the first trimester), 88.9%(16/18, the second trimester), 78.9% (15/19, the third trimester), respectively. There was a high-flow,low-resistance hemodynamic state during normal pregnancy. TPR decreased during all three trimesters of pregnancy(P<0.01),the lowest in the third trimester. MBP changed slightly throughout pregnancy(P>0.05). During gestational period the healthy pregnant women's cardiovascular system remodeled because of the growth of circulation volume and the long-term overloading. With the gestational development, the healthy pregnant women's left atrial and ventricular diameter and volume (LAs, LAVmax, LAVmin, LVEDd, LVEDV, LVESV), stroke volume (LASV, LVSV), LVCO and LVCI increased gradually, peaked in the last weeks of pregnancy(P<0.05,P<0.01,P<0.001). LVCO increased in early pregnancy,as a result of the increased HR and SV, they correlated linearly with r=0.728 ,(P<0.0001)and r=0.866,(P<0.0001),respectively. IVSd, LVPWd, LVM and LVMI peaked in the third trimester (P<0.05,P<0.01).They all showed left ventricular hypertrophy in the late duration of pregnancy. The left atrial and ventricular systolic function(LAEF, LVEF, PER)seemed to be slightly increased during midpregnancy(P>0.05).While the left ventricular diastole function decreased a little through gestation(P<0.05),but remained in the normal range, LVPFR seemed to be slightly increased during midpregnancy too(P>0.05), showing the compensasive increasing of left ventricular initiative filling ability.Conclusions: Maternal cardiovascular adaptive changes in pregnancy are active preparations. As a new means of reflecting cardiac remodeling and hemodynamic changes in pregnancy ,FV-3DE will be used in evaluating healthy pregnant women cardiac function by clinical routine gradually.