Left ventricular systolic and diastolic function in pregnant patients with sickle cell disease

Our purpose was to document noninvasively the effect of sickle cell disease on left ventricular systolic and diastolic function during the third trimester of pregnancy.

Fifteen patients with sickle cell disease underwent a two-dimensional M-mode echocardiography obtained using the long axis with the cursor placed at the level of the tip of the mitral valve. All studies were performed with the patient in the left lateral decubitus. A group of 40 normal pregnant patients served as controls. None of the patients had evidence of cardiovascular disease. Left atrial and ventricular dimensions and mass were calculated and averaged. Left ventricular systolic and diastolic function were assessed.

Pregnant patients with sickle cell disease had a significant enlargement of the left ventricular end-diastolic dimension, posterior wall, interventricular septum, and ventricular mass than the control group. Although heart rate and fractional shortening were not different between the two groups, stroke volume and cardiac output were higher in patients with sickle cell disease. This was mostly because of enlargement of left end-diastolic dimension. Ventricular diastolic function was different in patients with sickle cell disease, resulting in an increase in the duration of the rapid filling.

Left ventricular systolic function in patients with sickle cell disease was not affected in spite of a marked ventricular hypertrophy and ventricular enlargement. Diastolic function, however, was lower in the sickle cell group, which indicates a decrease in ventricular compliance. These patients had a higher cardiac output than did a normal pregnant group in the third trimester. This was accomplished by increasing ventricular size without increasing heart rate or fractional shortening.