Left atrial function during pregnancy: a three-dimensional echocardiographic study.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Cardiology, Barzilai Medical Center Campus, Ben-Gurion University, Ashkelon, Israel. yosefy@barzi.health.gov.il
Chaim
C
Yosefy
Simon
S
Shenhav
Viktor
V
Feldman
Yair
Y
Sagi
Amos
A
Katz
Eyal
E
Anteby
D000328:Adult; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D011247:Pregnancy / Q000502:physiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity