A Preliminary Study On The Evaluation Of Left Atrial Configuration And Function Of Healthy Pregnant Women In Late Pregnancy And Postpartum By Ultrasonography

Objective: In the past,there have been more studies on the structure and function of the left ventricle in different pregnant periods,but less studies on the structure and function of the left atrium in late pregnancy and postpartum.The purpose of this study was to observe the structure and function of the left atrium of pregnant women of healthy age in the late pregnancy and postpartum in different periods by conventional echocardiography and two-dimensional speckle tracking imaging(2D-STI)technology,and to explore the changes of the structure and function of the left atrium in the late pregnancy and postpartum in healthy pregnant women.Method : 25 pregnant women in the third trimester of pregnancy in yijishan Hospital of Wannan Medical College from October 2018 to October 2019 were selected as the observation group,and 20 healthy non pregnant women matched were selected as the control group.All pregnant women in the observation group were examined by echocardiography in the late pregnancy(34-40 weeks),in the first week(3-7 days)and in the six week(42 days)after delivery,and retained The required image data were divided into three groups.The age,height,weight,blood pressure,heart rate and other basic data of the observation group were collected and recorded.The structure and function parameters of left ventricle were obtained by two-dimensional and Doppler ultrasound: left ventricular end diastolic diameter(LVEDd),left ventricular ejectionfraction(LVEF),cardiac output(CO),peak velocity(E,A)and E / A in early and late diastolic period of mitral valve were measured by pulse Doppler,and the peak value in early diastolic period of lmitral annulus was measured by tissue Doppler spectrum Velocity(Sep.e);obtain the configuration and functional parameters of left atrium by two-dimensional echocardiography: left atrial end systolic volume(LAD),left atrial maximum volume(LAVmax),left atrial pre systolic volume(LAVp)and left atrial minimum volume(LAVmin),and calculate the total left atrial emptying volume(TEV),left atrial passive emptying volume(PEV),left atrial active emptying Volume(AEV),left atrial total ejection fraction(LATEF),left atrial passive ejection fraction(LAPEF),left atrial active ejection fraction(LAAEF),dilation index(LAEI).Measurement of strain rate parameters related to left atrial function by 2D-STI: systolic peak strain rate(SRs),early diastolic peak strain rate(SRe),late diastolic peak strain rate(SRa),and the mean peak strain rate of left atrium was calculated.The effects of pregnancy and delivery on the structure and function of left atrium were analyzed.Results: there were significant differences in heart rate,body weight,body surface area and body mass index at test between the late pregnancy group,postpartum 1 week,postpartum 6 weeks and the normal control group(P < 0.01).The adaptive changes of structure and function of left atrium and left ventricle were observed in healthy pregnant women under long-term volume overload.The main changes were as follows:(1)left ventricular structure and function indexes: CO and LVEDd increased in late pregnancy and decreased in postpartum,which was statistically significant compared with the 6-week postpartum group and the control group(P < 0.01);LVEF,E / A ratio,Sep.e decreased in late pregnancy and increased in postpartum,and the differences were statistically significant in late pregnancy,1-week postpartum,6-week postpartum and the control group(P < 0.05 or P < 0.01).(2)Left atrial structure and function indexes:LAD,LAVmax,LAVmin and LAVp increased in late pregnancy group,but decreased in postpartum group.The indexes of late pregnancy and one week postpartum groupwere significantly higher than those of seven weeks postpartum group and normal control group(P < 0.01).In late pregnancy,TEV,AEV,LATEF,LAAEF and LAEI increased,while in postpartum,they decreased.In late pregnancy,there was statistical significance compared with the 6-week postpartum group and the normal control group(P < 0.01).There was no significant difference between the 6-week postpartum group and the normal control group(P > 0.05).PEV and LAPEF decreased in late pregnancy,and increased in postpartum.The indexes of late pregnancy were statistically significant(P < 0.01 or P < 0.05)compared with the 6-week postpartum group and the normal control group.There was no significant difference between the 6-week postpartum group and the normal control group(P > 0.05).(3)The mSRa and mSRs increased in late pregnancy,and decreased in postpartum.There was a significant difference between late pregnancy group and 6 weeks postpartum group and normal control group(P < 0.01).The mSRe decreased in late pregnancy and increased in postpartum.There was significant difference between the late pregnancy group and the postpartum one week group compared with the postpartum seven weeks group and the normal control group(P < 0.01 or P < 0.05).There was no significant difference in mSRa,mSRe and mSRs between 6 weeks postpartum group and normal control group(P > 0.05).Conclusion: 1.In the third trimester of pregnancy,the configuration and function of the left atrium of healthy pregnant women showed adaptive changes,such as the enlargement of the left atrium,the enhancement of storage function and pump function,and the decrease of the function of the conduit.2.The configuration and functional parameters of the left atrium of healthy pregnant women changed gradually,and recovered to the pre pregnancy level at the end of puerperium.