Evaluation Of Maternal Function And Motion Of Left Ventricle In Severe Preeclampsia And Normal Pregnancy By Three-plane Tissue Doppler Imaging

ObjectiveUsing three-plane quantitative tissue velocity imaging(Triplane-QTVI) and three-plane tissue synchronization imaging(Triplane-TSI) to evaluate maternal function and motion of left ventricle in severe preeclampsia(SPE) and normal pregnant women(NP), and to evaluate the clinical value of three-plane tissue Doppler imaging(Triplane-TDI).MethodsForty single-pregnant women with SPE, 44 cases of normal single-pregnant women(NP), 40 cases healthy and no pregnant women(C) were involved.We got the left ventricular end diastolic period diameter(LVEdd), left ventricular end systolic period diameter(LVEds), inter ventricular septal thickness(IVSd) and post wall thickness(PWd) by M-mode echocardiographies and then calculated the relative wall thickness(RWT). Early diastolic velocity of mitral valve(E) was obtained by spectral Doppler echocardiographies. We got end systolic period volume(ESV), end diastolic period volume(EDV), ejection fraction(EF), cardic output(CO), sphericity index(Sp I) by three-dimensional ultrasound. By The standardization to body surface area, we got left ventricular mass index(LVMi),cardic index(CI), left atrium volume index(LAVi). Using Triplane-QTVI, we got the QTVI curve of the left ventricular walls at 12 points, recorded the time to peak systolic velocity(Ts) and diastolic velocity(Te), then calculated the maximal difference and the standard deviation of different time periods(Ts-max%, Ts-SD%,Te- max%, Te-SD%), recorded the mean value of systolic, early and late diastolic peak velocity of different segments(s, e, a) and E/e. Next, using Triplane-TSI, we got the time to peak systolic velocity of 12 segments of the left ventricle and by standardization to heart rate, we obtained the maximal difference and the standard deviation of different time periods(12-dif%, 12-SD%). Then, we compared the measuring time of Triplane-QTVI and Triplane-TSI.Results1 The comparison of general clinical data Group SPE: compared with group NP and group C,group SPE had higher blood pressure(P﹤0.05) and had no significant differences in age of all the participants(P﹥0.05), The gestational age between group SPE and group NP had no significant differences(P﹥0.05). Group NP: blood pressure between group NP and group C had no significant differences(P﹥0.05), while the heart rate in group NP were higher than the other groups(P﹤0.05). 2 The evaluation of morphology of left ventricle Group SPE: in all of the morphological indexes, compared with group NP and group C, group SPE had higher IVSd, PWd, Sp I, RWT, LVMi, EDV, ESV, LVEdd and LVEds(P﹤0.05). Group NP: compared with group C, only LVMi of group NP increased significantly(P﹤0.05).3 The evaluation of the function of left ventricle3.1 The evaluation of systolic function Group SPE: compared with group NP and group C, the systolic function of group SPE decreased significantly. It was manifested as the reduction of the evaluating index s of Triplane-TDI and other echocardiographic index EF(P﹤0.05).Group NP: all of the indexes of systolic function of group NP had no significant difference with group C. According to the correlation analysis, there was a significant positive correlation between s and EF.3.2 The evaluation of diastolic function Group SPE: compared with group NP and group C, the diastolic function of group SPE decreased significantly. It was manifested as the decrease of evaluating index e of Triplane-TDI and the the increase of E/e and LAVi(P﹤0.05). Group NP:E/e in group NP was higher than group C. According to the correlation analysis, there was a significantly negative correlation between e and E/e as well as LAVi.Meanwhile, there was a significantly positive correlation between a and E/e(P ﹤0.05).4 The evaluation of the synchrony of the motion of the left ventricle Group SPE: Ts-max%, Ts-SD%, Te-SD%, 12-dif%, 12-SD% in group SPE were extended compared with group NP. The differences had statistical significant(P ﹤0.05). Group NP: compared with group C, there were no significant differences with time interval indexes in group NP(P﹥0.05).5 Correlation analysis between the synchrony of left ventricle and the remolding and function of left ventricle The time interval indexes of left ventricle had a positive correlation with the morphological indcxes of left ventricle, such as EDV, ESV, IVSd, PWd, Sp I, LVMi and RWT. Ts-max%, Ts-SD%, 12-dif%, 12-SD% had a negative correlation with heart function indexes(EF,s,e), and had a positive correlation with E/e, LAVi.Te-max%, Te-SD% had a negative correlation with e and had a positive correlation with a. The correlation had statistical significant(P﹤0.05).6 Comparative analysis between Triplane-QTVI and Triplane-TSI It took longer to measure the time indexes by Triplane-QTVI(4.26±0.37min)than by Triplane-TSI(2.04±0.26min). The differences had statistical significant(P﹤0.05). 12-diff%, 12-SD%of Triplane-TSI indexes had a strong positive correlation with Ts-max%, Ts-SD% of Triplane-QTVI indexes.Conclusions1 The left ventricle of patients with SPE appeared eccentric hypertrophy. Both of the systolic function and diastolic function of left ventricle in the women with SPE were impaired. The synchrony of the left ventricular motion in women with SPE decreased.2 The structure and function of left ventricle in normal pregnant women changed slightly, and the synchrony of the left ventricular motion had no difference with the healthy and no pregnant women.3 Triplane-TDI could evaluate the maternal function and motion of left ventricle in severe preeclampsia and normal pregnant women noninvasively, so Triplane-TDI could be widely used in clinical diagnosis and treatments, when evaluating the systolic synchrony, Triplane-TSI was faster than Triplane-QTVI.