Quantitative analysis of left atrial volume and function during normotensive and preeclamptic pregnancy: a real-time three-dimensional echocardiography study

Abstract

The changes in left atrial (LA) size and function during normotensive and preeclamptic (PE) pregnancy have rarely been previously studied and the results have been inconsistent. The aim of this study was to assess the time changes in LA volume during normal pregnancy, to determine the impact of the increased afterload occurring in PE on maternal LA, and to compare differences in LA geometry and function between early-onset and late-onset PE. Using a real time three-dimensional echocardiograph, the body surface area-indexed LA volume and emptying function (EF) were compared between nonpregnant controls (n = 30), normotensive (n = 43), and PE (36 with early-onset PE and 34 with late-onset PE) pregnant women. During normotensive pregnancy, the indexed LA maximum, pre-contraction, and minimum volumes progressively increased, as well as total, passive, and active EF (P < 0.05, Trimester 3 vs. controls), as an adaption to risen cardiac preload. In the PE group, indexed LA volumes were significantly enlarged and the values of LA EF were markedly decreased (P < 0.05) resulting from elevated ventricular filling pressure and diastolic dysfunction. Compared with late-onset PE, smaller LA volume and greater atrial EF were shown in early-onset PE despite a higher afterload and more hypertrophied ventricle. In conclusion, LA size and function gradually improved to maintain adequate blood volume during normotensive pregnancy, while dilated chamber and reduced action of LA occurred in PE associated with increased afterload. Less LA volume and higher LA EF were shown in early-onset PE than in late-onset PE.

Cardiac remodeling in normotensive pregnancy and in pregnancy complicated by hypertension: systematic review and meta‐analysis

“…Melchiorre (2016) 3 50 0.01 (-0.01 to 0.03) Cong (2015) 21 43 30 0.02 (-0.02 to 0.06) Cong (2015) 34 68 68 0.01 (-0.01 to 0.03) Savu (2012) 40 46 31 0.01 (-0.01 to 0.03) Simmons (2002) 1 44 44 0.01 (0.00 to 0.02) Summary 310 223 0.01 (0.00 to 0.02)…”

“…Melchiorre (2016) 3 50 0.01 (-0.01 to 0.03) Cong (2015) 21 43 30 0.03 (-0.01 to 0.07) Cong (2015) 34 68 68 0.02 (0.00 to 0.04) Savu (2012) 40 49 31 0.02 (0.00 to 0.04) Yoon (2011) 43 In pregnancies complicated by hypertension, RWT increased by 0.05 (95% CI, 0.02-0.08) (% change, 15.02 (95% CI, 6.01-24.04)%) between 22 and 28 weeks compared with reference and continued to increase until 29-35 weeks, at which point the mean difference was 0.06 (95% CI, 0.04-0.09) (% change, 18.11 (95% CI, 12.07-27.16)%). In addition to pre-eclamptic pregnancies, the latter interval included pregnancies complicated by PIH from one study 18 .…”

“…In addition to pre-eclamptic pregnancies, the latter interval included pregnancies complicated by PIH from one study 18 . At term, only one included study investigated RWT in pregnancies complicated by late-onset pre-eclampsia (n = 34) 21 . Compared with non-pregnant controls, an increase of 0.14 (95% CI, 0.09-0.19) (% increase, 56.00 (95% CI, 36.00-76.00)%) was observed (Table 4, Figure 5).…”

“…LVEDD increased by 0.18 (95% CI, 0.10-0.26) cm (% change, 3.85 (95% CI, 2.14-5.56)%) between 29 and 35 weeks compared with reference (Table 4, Figure S8). Only one included study reported LVEDD between 36 and 41 weeks, with a value of 0.33 (95% CI, 0.14-0.52) cm (% change, 7.47 (95% CI, 3.17-11.77)%) 21 . We did not find a statistically significant difference in LVEDD increase between pregnancies complicated by hypertension and normotensive pregnancies (P = 0.96).…”

Impact of a History of Hypertension in Pregnancy on Later Diagnosis of Atrial Fibrillation

“…Acute myocardial manifestations of the HPDs include concentric remodeling, left ventricular hypertrophy, and diastolic dysfunction,10 which results in left atrial enlargement,11 accompanied by increased atrial natriuretic peptide levels 12. Over the long term, women with a history of HPD have higher left ventricular mass and higher prevalence (odds ratio: 1.4) of left ventricular hypertrophy compared with women with normotensive pregnancies,13 as well as a higher likelihood of an abnormal index of myocardial performance 14…”