Quantitative cardiovascular magnetic resonance in pregnant women: cross-sectional analysis of physiological parameters throughout pregnancy and the impact of the supine positionReport as inadecuate




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Journal of Cardiovascular Magnetic Resonance

, 13:31

First Online: 27 June 2011Received: 17 January 2011Accepted: 27 June 2011

Abstract

BackgroundThere are physiological reasons for the effects of positioning on hemodynamic variables and cardiac dimensions related to altered intra-abdominal and intra-thoracic pressures. This problem is especially evident in pregnant women due to the additional aorto-caval compression by the enlarged uterus. The purpose of this study was to investigate the effect of postural changes on cardiac dimensions and function during mid and late pregnancy using cardiovascular magnetic resonance CMR.

MethodsHealthy non-pregnant women, pregnant women at 20 week of gestation and at 32 week of gestation without history of cardiac disease were recruited to the study and underwent CMR in supine and left lateral positions. Cardiac hemodynamic parameters and dimensions were measured and compared between both positions.

ResultsFive non-pregnant women, 6 healthy pregnant women at mid pregnancy and 8 healthy pregnant women at late pregnancy were enrolled in the study. In the group of non-pregnant women left ventricular LV cardiac output CO significantly decreased by 9% p = 0.043 and right ventricular RV end-diastolic volume EDV significantly increased by 5% p = 0.043 from the supine to the left lateral position. During mid pregnancy LV ejection fraction EF, stroke volume SV, left atrium lateral diameter and left atrial supero-inferior diameter increased significantly from the supine position to the left lateral position: 8%, 27%, 5% and 11%, respectively p < 0.05. RV EDV, SV and right atrium supero-inferior diameter significantly increased from the supine to the left lateral position: 25%, 31% and 13% p < 0.05, respectively. During late pregnancy a significant increment of LV EF, EDV, SV and CO was observed in the left lateral position: 11%, 21%, 35% and 24% p < 0.05, respectively. Left atrial diameters were significantly larger in the left lateral position compared to the supine position p < 0.05. RV CO was significantly increased in the left lateral position compared to the supine position p < 0.05.

ConclusionsDuring pregnancy positional changes affect significantly cardiac hemodynamic parameters and dimensions. Pregnant women who need serial studies by CMR should be imaged in a consistent position. From as early as 20 weeks the left lateral position should be preferred on the supine position because it positively affects venous return, SV and CO.

List of abbreviationsCMRcardiovascular magnetic resonance

SAshort-axis

EDVend-diastolic volume

ESVend-systolic volume

EFejection fraction

SVstroke volume

COcardiac output

LVleft ventricle

RVright ventricle

LAleft atrium

RAright atrium

LAlatlateral left atrium diameter

LAsisupero-inferior left atrium diameter

RAlatlateral right atrium diameter

RAsisupero-inferior right atrium diameter

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-13-31 contains supplementary material, which is available to authorized users.

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Author: Alexia Rossi - Jerome Cornette - Mark R Johnson - Yusuf Karamermer - Tirza Springeling - Petra Opic - Adriaan Moelker - Ga

Source: https://link.springer.com/article/10.1186/1532-429X-13-31







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