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. 2011 Jun 27;13(1):31.
doi: 10.1186/1532-429X-13-31.

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

Alexia Rossi  1 , Jerome Cornette, Mark R Johnson, Yusuf Karamermer, Tirza Springeling, Petra Opic, Adriaan Moelker, Gabriel P Krestin, Eric Steegers, Jolien Roos-Hesselink, Robert-Jan M van Geuns
Affiliations

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

Alexia Rossi et al. J Cardiovasc Magn Reson. .

Abstract

Background: There 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).

Methods: Healthy non-pregnant women, pregnant women at 20th week of gestation and at 32nd 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.

Results: Five 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).

Conclusions: During 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.

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Figures

Figure 1
Figure 1
Cardiac dimensions: four-chamber end-systolic view. LAlat: left atrium lateral diameter; LAsi: left atrium supero-inferior diameter; RAlat: right atrium lateral diameter: RAsi: right atrium supero-inferior diameter.
Figure 2
Figure 2
Percentage differences of hemodynamic parameters of left side of the heart. EF (ejection fraction: %), EDV (end-diastolic volume: ml), ESV (end-systolic volume: ml), SV (stroke volume: ml), CO (cardiac output: L/min), LAvol (left atrium volume: ml) Percentage difference from supine to left lateral position is calculated with the following formula: X (%) = [(Xlateral - Xsupine)/(Xsupine)] × 100 where X is a cardiac parameter.
Figure 3
Figure 3
Percentage differences of hemodynamic parameters of right side of the heart. EF (ejection fraction: %), EDV (end-diastolic volume: ml), ESV (end-systolic volume: ml), SV (stroke volume: ml), CO (cardiac output: L/min), LAvol (left atrium volume: ml) Percentage difference from supine to left lateral position is calculated with the following formula: X (%) = [(Xlateral - Xsupine)/(Xsupine)] × 100 where X is a cardiac parameter.
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