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Updated: May 14, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Impact of Three-Dimensional Assessment of Maternal Left Ventricular Systolic Function on Pregnancy Outcomes
Aleksandra Ilić1,2, Snežana Tadić1,2, Maja Stefanović1,2
1Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.
Insights
Three-dimensional echocardiography reveals impaired left ventricle systolic function in hypertensive disorders of pregnancy (HDP). This dysfunction predicts adverse outcomes like intrauterine growth restriction and preterm delivery.
Area of Science:
- Cardiology
- Obstetrics
- Medical Imaging
Background:
- Hypertensive disorders in pregnancy (HDP) are linked to poor pregnancy outcomes.
- Three-dimensional (3D) echocardiography enhances cardiac assessment accuracy during pregnancy.
Purpose of the Study:
- To evaluate the impact of 3D left ventricle (LV) systolic function in HDP on pregnancy outcomes.
- To identify predictors of intrauterine growth restriction (IUGR) and preterm delivery in HDP pregnancies.
Main Methods:
- Prospective cohort study of primiparous women with singleton pregnancies.
- Inclusion of medical history, laboratory tests, ambulatory blood pressure monitoring, and 2D/3D echocardiography.
- Comparison of 174 HDP patients with 64 controls, analyzing pregnancy outcomes (IUGR, preterm delivery, birth weight).
Main Results:
- HDP patients showed significantly impaired LV systolic and diastolic function compared to controls.
- 3D LV global area strain (GAS) and ejection fraction (EF) were key predictors of IUGR and preterm delivery, respectively.
- Models incorporating BMI, 3D LV GAS, nighttime SBP, and 3D LV EF demonstrated high predictive accuracy for adverse outcomes.
Conclusions:
- 3D LV GAS is a significant predictor of IUGR and correlates positively with birth weight.
- 3D LV EF strongly predicts preterm delivery in pregnancies with hypertensive disorders.
Background:
Hypertensive disorders in pregnancy (HDP) are associated with adverse pregnancy outcomes. Three-dimensional (3D) echocardiography provides greater accuracy for assessing cardiac geometry and function during pregnancy. The aim was to assess the impact of the 3D left ventricle (LV) systolic function in HDP on pregnancy outcomes.
Methods:
The prospective cohort study included primiparous with singleton pregnancies, without previous comorbidities who underwent medical history assessment, laboratory tests, ambulatory blood pressure monitoring (ABPM), and transthoracic echocardiography at baseline and six weeks after delivery. Participants were divided into a HDP group and a control group. Pregnancy outcomes (intrauterine growth restriction (IUGR), preterm delivery, and birth weight) were recorded and analyzed.
Results:
The study involved 174 HDPs and 64 controls, with a median gestational age of 34 weeks (31; 36). Compared to controls HDP exhibited significantly impaired values in both two-dimensional (2D) and 3D parameters for the systolic and diastolic function of the LV. They had higher LV mass index values and lower absolute values for 2D global longitudinal strain and 3D LV strain in all directions (p < 0.001). Multivariable regression analysis revealed that body mass index (BMI) with odds ratio (OR) of 0.751 (95% confidence interval (CI): 0.666-0.847, p < 0.001) and 3D LV global area strain (GAS) with OR of 0.234 (95% CI: 0.155-0.352, p < 0.001) were the strongest predictors of IUGR, while BMI with OR of 0.832 (95% CI: 0.758-0.914), nighttime systolic blood pressure (SBP) with OR of 1.055 (95% CI: 1.032-1.079, p < 0.01) and 3D LV ejection fraction (EF) with OR of 0.780 (95% CI: 0.687-0.885) were the strongest predictors of preterm delivery. The receiver operating characteristic (ROC) curve showed that the model with BMI and 3D LV GAS can be a good predictor for IUGR with an area under the curve (AUC) 0.951 (0.925-0.976) with 89.5% sensitivity and 86.4% specificity, p < 0.001, while the model with BMI, nighttime SBP and 3D LV EF is a predictor for preterm delivery with AUC of 0.835 (0.776-0.893) with 79.1% sensitivity and 73.7% specificity, p < 0.001. Person correlation showed a significant positive correlation between birth weight and 3D GAS, r = 0.485; p < 0.001.
Conclusions:
LV GAS is significantly associated with IUGR and birth weight, while 3D LV EF strongly predicts preterm delivery.
