Evaluation Of Characteristics Of Right Ventricle In Severe Preeclampsia Women By Tissue Doppler Imaging

Objective To evaluate structural and functional characteristics of right ventricle in severe preeclampsia(SPE) patients and normal pregnant women by tissue Doppler imaging(TDI)and to explore the function of right ventricle in the development of cardiovascular disease caused by SPE.Methods Patients were collected in the Third Affiliated Hospital of Zhengzhou University from June 2014 to December 2014. Forty-seven severe preeclampsia patients(Group SPE) and 39 normal pregnant women(Group N) with non obstetric complications were selected. Twenty healthy non pregnant women were the control group(Group C).Three groups of age matched, meanwhile SPE patients and normal pregnant women were matched for gestational age. We used two dimensional echocardiography to measure left ventricular end diastolic diameter(LVEDd), left atrial diameter(LAd), right ventricular anterior wall thickness(RVAW), right ventricular end diastolic diameter(RV-D) and right atrial area(RA-A). Interventricular septum thickness and left ventricular posterior wall thickness were measured to calculate the relative thickness of the left ventricular wall(LV-RWT). By using flow Doppler spectrum echocardiography, we obtained the early diastolic blood flow velocity and late diastolic blood flow velocity of mitral valve and tricuspid valve. Pulmonary arterial systolic pressure(PASP) was were measured by tricuspid valve regurgitation method. Mitral annular systolic excursion(MAPSE) and tricuspid annual systolic excursion(TAPSE) were obtained by M-mode echocardiography. The peak systolic velocity(s), early diastolic peak velocity(e) and late diastolic peak velocity(a) of the mitral annulus and tricuspid annulus were measured by tissue Doppler imaging. The time to peak systolic and diastolic velocity(Ts、Te、Ta)of both ventricles were acquired by TDI. The maximal differences of the time to peak systolic and diastolic velocity between two ventricles were calculated. All time interval indexes were standardized to heart rate. All the indexes were selected for the average of three times measurements value.Results 1 Comparison of general clinical data Compared with group N and C: the systolic blood pressure and diastolic blood pressure of group SPE were significantly increased(P < 0.05). There was no significant difference in gestational age between group SPE and N. Compared to group C, group N had slightly higher systolic blood pressure and diastolic blood pressure,as well as increased heart rate(P < 0.05). There was no significant difference in age in these three groups(P>0.05). 2 The evaluation of left heart morphology and functionThere were significantly larger LVMi, LVEDd, LAd and LV-RWT in SPE patients. MAPSE and tissue Doppler velocity of mitral annulus s reduced, while E/e and e/a increased in group SPE versus group N and C(P<0.05). Group N had higher E/e and LVMi than group C(P<0.05),meanwhile, group N had no significant difference in other indexes compared to group C(P>0.05). 3 The evaluation of right heart morphology and function The right ventricle and atrium dilated, as well as right ventricular wall thickened occurred in group SPE Compared with group N, increased tissue Doppler velocity of tricuspid annulus a、E/A and PASP were showed in group SPE. Moreover, SPE patients had decreased TAPSE and tissue Doppler velocity of tricuspid annulus e/a than normal pregnant women.(P<0.05). Group N: compared to C group, there was no significant difference in right heart morphological structure and function(P>0.05). 4 The evaluation of synchrony of ventricular motion Compared with group N and C, group SPE had longer RV-LV-Ts-max%, RV-LV-Ta-max% of interventricular, and RV-IVS-Te-max%, RV-IVS-Ta-max%, RV-IVS-Ts-max% of right ventricle(P<0.05). 5 Analysis of factors affecting the synchrony of ventricular movement RV-LV-Ts-max% and RV-IVS-Ts-max% were positively correlated with blood pressure, left ventricular morphologic index, and negative correlation with cardiac function indexes.(P<0.05). MAPSE and TAPSE, tissue Doppler velocity of mitral annulus e/a and tricuspid annulus e/a have correlation, respectively.Conclusions SPE patients showed enlarged chambers, impaired systolic and diastolic function of right ventricle. Besides, there was significant intraventricular dyssynchrony and right ventricular dyssynchrony in SPE patients.