Longitudinal changes in maternal left atrial volume index and uterine artery pulsatility indices in uncomplicated pregnancy

Abstract Background Data on the relationship between longitudinal changes of maternal volume-dependent echocardiographic parameters and placentation in uncomplicated pregnancy are limited. Objective (s): To evaluate changes of volume-dependent echocardiographic parameters in uncomplicated pregnancy. To test the hypothesis of the existence of an association between volume-dependent echocardiographic parameters and Doppler ultrasound parameters of fetal circulation and the uterine artery in uncomplicated pregnancy and to establish which of volume-dependent echocardiographic parameters best depicts volume changes and correlates best with Doppler ultrasound of fetal circulation and the uterine artery in healthy pregnancy. Study Design Data from 60 healthy pregnant women were analyzed. A complete echocardiographic study was performed at 11-13, 20-22 and 30-32 weeks of pregnancy: left ventricle end diastolic volume (LVEDV), early diastolic peak flow velocity (E velocity), late diastolic peak flow velocity, left atrium area (LAA) and left atrium volume index (LAVI) were assessed. Obstetrical assessment was performed including: fetal growth, uterine artery pulsatility index (PI). Fetal wellbeing was assessed by umbilical and middle cerebral artery blood flow. Serum pregnancy associated plasma protein A (PAPP-A) and free s-hCG were assessed during routine first trimester scan (11-13 weeks). Results LVEDV and LAA increased significantly between 11-13 and 20-22 weeks but not between 20-22 and 30-32 weeks. LAVI measured at 30-32 weeks correlated with uterine artery pulsatility indices in three trimesters. Changes in LAVI between third and first trimester correlated significantly with UtA PI measured at 20-22 weeks (r=-0.345;p=0.020) and at 30–32 weeks (r=-0.452;p=0.002). Changes in LAVI between second and first trimester significantly correlated with UtA PI measured in the first trimester (r=-0.316;p=0.025). Conclusion (s): Our study showed for the first time that in uncomplicated pregnancy among volume-dependent echocardiographic parameters LAVI increased both between first and second as well as second and third trimester and correlated with parameters of Doppler ultrasound of fetal circulation and the uterine artery. Our results expand previous observation on the relationship between maternal cardiovascular adaptation and placentation in women with heart diseases to the population of healthy women with uncomplicated pregnancy.