LEFT-VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION IN PREGNANT PATIENTSWITH SICKLE-CELL DISEASE

OBJECTIVE: Our purpose was to document noninvasively the effect of sic kle cell disease on left ventricular systolic and diastolic function d uring the third trimester of pregnancy. STUDY DESIGN: Fifteen patients with sickle cell disease underwent a two-dimensional M-mode echocardi ography obtained using the long axis with the cursor placed at the lev el 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 card iovascular disease. Left atrial and Ventricular dimensions and mass we re calculated and averaged. Left ventricular systolic and diastolic fu nction were assessed. RESULTS: Pregnant patients with sickle cell dise ase had a significant enlargement of the left ventricular end-diastoli c dimension, posterior wall, interventricular septum, and Ventricular mass than the control group. Although heart rate and fractional shorte ning were not different between the two groups, stroke volume and card iac output were higher in patients with sickle cell disease. This was mostly because of enlargement of left end-diastolic dimension. Ventric ular diastolic function was different in patients with sickle cell dis ease, resulting in an increase in the duration of the rapid filling. C ONCLUSION: Left ventricular systolic function in patients with sickle cell disease was not affected in spite of a marked ventricular hypertr ophy and ventricular enlargement. Diastolic function, however, was low er in the sickle cell group, which indicates a decrease in Ventricular compliance. These patients had a higher cardiac output than did a nor mal pregnant group in the third trimester. This was accomplished by in creasing ventricular size without increasing heart rate or fractional shortening.