Skip to main content

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

The International Journal of Cardiovascular Imaging volume 31, pages 805–812 (2015)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Walker JJ (2000) Pre-eclampsia. Lancet 356:1260–1265

    Article  CAS  PubMed  Google Scholar 

  2. Valensise H, Vasapollo B, Gagliardi G, Novelli GP (2008) Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease. Hypertension 52:873–880

    Article  CAS  PubMed  Google Scholar 

  3. von Dadelszen P, Magee LA, Roberts JM (2003) Subclassification of preeclampsia. Hypertens Pregnancy 22:143–148

    Article  Google Scholar 

  4. Huppertz B (2008) Placental origins of preeclampsia: challenging the current hypothesis. Hypertension 51:970–975

    Article  CAS  PubMed  Google Scholar 

  5. Presbitero P, Boccuzzi GG, Groot CJ, Roos-Hesselink JW (2009) ESC textbook of cardiovascular medicine. Oxford University Press, Oxford

    Google Scholar 

  6. Roth A, Elkayam U (2008) Acute myocardial infarction associated with pregnancy. J Am Coll Cardiol 52:171–180

    Article  PubMed  Google Scholar 

  7. Kealey A (2010) Coronary artery disease and myocardial infarction in pregnancy: a review of epidemiology, diagnosis, and medical and surgical management. Can J Cardiol 26:185–189

    Article  PubMed  Google Scholar 

  8. Bauer TW, Moore GW, Hutchins GM (1982) Morphologic evidence for coronary artery spasm in eclampsia. Circulation 65:255–259

    Article  CAS  PubMed  Google Scholar 

  9. Melchiorre K, Thilaganathan B (2011) Maternal cardiac function in preeclampsia. Curr Opin Obstet Gynecol 23:440–447

    Article  PubMed  Google Scholar 

  10. Beinart R, Boyko V, Schwammenthal E, Kuperstein R, Sagie A, Hod H, Matetzky S, Behar S, Eldar M, Feinberg MS (2004) Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol 44:327–334

    Article  PubMed  Google Scholar 

  11. Tsang TS, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, Cha SS, Seward JB (2006) Prediction of cardiovascular outcomes with left atrial size: Is volume superior to area or diameter? J Am Coll Cardiol 47:1018–1023

    Article  PubMed  Google Scholar 

  12. Ingec M, Yilmaz M, Gundogdu F (2005) Left atrial mechanical functions in pre-eclampsia. J Obstet Gynaecol Res 31:535–539

    Article  PubMed  Google Scholar 

  13. Melchiorre K, Sutherland GR, Baltabaeva A, Liberati M, Thilaganathan B (2011) Maternal cardiac dysfunction and remodeling in women with preeclampsia at term. Hypertension 57:85–93

    Article  CAS  PubMed  Google Scholar 

  14. Rafik Hamad R, Larsson A, Pernow J, Bremme K, Eriksson MJ (2009) Assessment of left ventricular structure and function in preeclampsia by echocardiography and cardiovascular biomarkers. J Hypertens 27:2257–2264

    Article  PubMed  Google Scholar 

  15. Nagaya M, Kawasaki M, Tanaka R, Onishi N, Sato N, Ono K, Watanabe T, Minatoguchi S, Miwa H, Goto Y, Hirose T, Arai M, Noda T, Watanabe S (2013) Quantitative validation of left atrial structure and function by two-dimensional and three-dimensional speckle tracking echocardiography: a comparative study with three-dimensional computed tomography. J Cardiol 62:188–194

    Article  PubMed  Google Scholar 

  16. Keller AM, Gopal AS, King DL (2000) Left and right atrial volume by freehand three-dimensional echocardiography: in vivo validation using magnetic resonance imaging. Eur J Echocardiogr 1:55–65

    Article  CAS  PubMed  Google Scholar 

  17. Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM (2001) The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 20:IX–XIV

    Article  CAS  PubMed  Google Scholar 

  18. Savu O, Jurcut R, Giusca S, van Mieghem T, Gussi I, Popescu BA, Ginghina C, Rademakers F, Deprest J, Voigt JU (2012) Morphological and functional adaptation of the maternal heart during pregnancy. Circ Cardiovasc Imaging 5:289–297

    Article  PubMed  Google Scholar 

  19. Mor-Avi V, Lang RM (2009) The use of real-time three-dimensional echocardiography for the quantification of left ventricular volumes and function. Curr Opin Cardiol 24:402–409

    Article  PubMed  Google Scholar 

  20. Dewey FE, Rosenthal D, Murphy DJ Jr, Froelicher VF, Ashley EA (2008) Does size matter? Clinical applications of scaling cardiac size and function for body size. Circulation 117:2279–2287

    Article  PubMed  Google Scholar 

  21. Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM (2003) Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol 41:1036–1043

    Article  PubMed  Google Scholar 

  22. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533

    Article  CAS  PubMed  Google Scholar 

  23. Yosefy C, Shenhav S, Feldman V, Sagi Y, Katz A, Anteby E (2012) Left atrial function during pregnancy: a three-dimensional echocardiographic study. Echocardiography 29:1096–1101

    Article  PubMed  Google Scholar 

  24. Abhayaratna WP, Fatema K, Barnes ME, Seward JB, Gersh BJ, Bailey KR, Casaclang-Verzosa G, Tsang TS (2008) Left atrial reservoir function as a potent marker for first atrial fibrillation or flutter in persons ≥65 years of age. Am J Cardiol 101:1626–1629

    Article  PubMed  Google Scholar 

  25. Hernandez-Diaz S, Toh S, Cnattingius S (2009) Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. BMJ (Clinical research ed) 338:b2255

    Google Scholar 

  26. Wikstrom AK, Larsson A, Eriksson UJ, Nash P, Norden-Lindeberg S, Olovsson M (2007) Placental growth factor and soluble FMS-like tyrosine kinase-1 in early-onset and late-onset preeclampsia. Obstet Gynecol 109:1368–1374

    Article  PubMed  Google Scholar 

  27. Stepan H, Unversucht A, Wessel N, Faber R (2007) Predictive value of maternal angiogenic factors in second trimester pregnancies with abnormal uterine perfusion. Hypertension 49:818–824

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Tianwei Zhao and Songyan Liu for skill training. This work was supported partially by the Henan Provincial Healthy Scientific and Technological Program (Grant ID_201203048) and partially by Henan Province Medical Academic Technology Leaders of Overseas Training Program (Grant ID_201201055).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China

    Juan Cong, Xiaoqian Yang, Nan Zhang, Tingpan Fan & Zhan Zhang

  2. Massachusetts General Hospital, Boston, MA, USA

    Jacson Shen

Authors
  1. Juan Cong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaoqian Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jacson Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tingpan Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhan Zhang.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cong, J., Yang, X., Zhang, N. et al. Quantitative analysis of left atrial volume and function during normotensive and preeclamptic pregnancy: a real-time three-dimensional echocardiography study. Int J Cardiovasc Imaging 31, 805–812 (2015). https://doi.org/10.1007/s10554-015-0628-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-015-0628-8

Keywords

  • Left atrium
  • Pregnancy
  • Preeclampsia
  • Three-dimensional echocardiograph