Yosefy Chaim, Shenhav Simon, Feldman Viktor, Sagi Yair, Katz Amos, Anteby Eyal
Department of Cardiology, Barzilai Medical Center Campus, Ben-Gurion University, Ashkelon, Israel.
Echocardiography. 2012 Oct;29(9):1096-101. doi: 10.1111/j.1540-8175.2012.01745.x. Epub 2012 Jun 14.
Alteration of diastolic function is considered a sensitive means for detecting changes in the normal cardiac adaptation to pregnancy. Our aim was to evaluate volumetric and functional atrial parameters, using real time three-dimensional echocardiography (RT3DE) in women in early and late third trimester of pregnancy.
We studied pregnant women in early third trimester (III-E = gestational age 26-33 weeks), in late third trimester (III-L = gestational age 34-40 weeks), and control nonpregnant women (C). Two-dimensional (2D-Echo) and RT3DE were used to study 3D left atrial (LA) systolic and diastolic stroke volumes and index (LASVI, LAEDVI), emptying fraction, left ventricular and LA cavities.
Although the LA end systolic volume index increased significantly (from 19.42 ± 0.1 to 24.7 ± 3.5 mm(2), P < 0.01), the EF did not change significantly. This was mainly achieved by increasing atrial contraction (A-wave), maintaining cardiac output by increasing heart rate. A decrease in diastolic E-wave, increased atrial kick (A-wave) with reduced E/A ratio, was noted as the pregnancy progressed. Pulmonary pressure increased from 16.9 ± 6.6 to 20.5 ± 2.9 mmHg (P < 0.01), Using 2D-Echo revealed no change in LA diameter from control to III-E and III-L, respectively (from 17.1 ± 2.3 to 16.7 ± 2.6, 17.5 ± 2.2 mm) and area (from 11.7 ± 3.1 to 16.5 ± 2.3, 17.6 ± 1.6 cm(2)). However, using RT3DE, a significant increase in the LASVI, LAEDVI, and LA stroke volume index (from 12.02 ± 2.5 to 14.7 ± 3.2, and 15.1 ± 2.7 mL/m(2)) was detected.
Enlargement of the LA volume with unchanged blood pressure values, as found using RT3DE, may be part of the adaptation to increased blood volume during pregnancy.
舒张功能改变被认为是检测正常心脏对妊娠适应变化的一种敏感方法。我们的目的是使用实时三维超声心动图（RT3DE）评估妊娠晚期和早期妇女的心房容积和功能参数。
我们研究了妊娠晚期（III-L = 孕周34 - 40周）、妊娠早期（III-E = 孕周26 - 33周）的孕妇以及对照非孕妇（C）。使用二维（2D-Echo）和RT3DE研究三维左心房（LA）收缩和舒张搏出量及指数（LASVI、LAEDVI）、排空分数、左心室和LA腔。
尽管左心房收缩末期容积指数显著增加（从19.42±0.1增至24.7±3.5 mm²，P < 0.01），但射血分数无显著变化。这主要通过增加心房收缩（A波）、提高心率维持心输出量来实现。随着妊娠进展，舒张期E波降低，心房收缩增强（A波），E/A比值降低。肺动脉压从16.9±6.6升至20.5±2.9 mmHg（P < 0.01），使用二维超声心动图显示从对照到III-E和III-L，左心房直径（分别从17.1±2.3至16.7±2.6、17.5±2.2 mm）和面积（从11.7±3.1至16.5±2.3、17.6±1.6 cm²）无变化。然而，使用RT3DE检测到LASVI、LAEDVI和左心房搏出量指数显著增加（从12.02±2.5至14.7±3.2以及15.1±2.7 mL/m²）。
使用RT3DE发现，在血压值不变的情况下左心房容积增大可能是妊娠期间对血容量增加的适应性变化的一部分。
