Cardiac Dimensions in Normal Pregnancy: A Prospective Study

BACKGROUND

Pregnancy, a unique physiologic state, is associated with several changes in the various body systems. The cardiovascular system is one of the systems affected, with chronic volume overload being one of the characteristic changes experienced during pregnancy. Cardiovascular disease in pregnancy is the leading cause of non-obstetric maternal death worldwide.

AIM

This study aims to determine and describe the changes in left and right ventricular and atrial sizes in systole and diastole in the course of normal pregnancy.

METHODS AND MATERIALS

A cohort study was conducted among healthy pregnant women between the age of 18 and 40 who attended the antenatal clinic of Federal Medical Centre (FMC), Yenagoa, Bayelsa State. Fifty women were recruited during the first trimester (T1) of pregnancy and followed up until six weeks postpartum. Ethical approval was obtained from the Research Ethics Committee of Federal Medical Centre, Yenagoa, with approval number FMCY/REC/ECC/2019/JAN/150. Clinical evaluation, hematologic, biochemical, and anthropometric assessments, and two-dimensional M-mode and Doppler echocardiography were done for the participants in each trimester of pregnancy and at six weeks postpartum. The clinical and echocardiographic parameters were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY, USA).

RESULTS

The mean trend of left ventricular posterior wall thickness in diastole (LVPWd) and left ventricular posterior wall thickness in systole (LVPWs) increased progressively from the first to third trimester (T3) (not statistically significant) but dropped toward initial values in postpartum to the level that was statistically significant for LVWPd alone when compared to baseline first trimester values. The left atrial diameter in systole (LADs) was largest in the third trimester, and the left atrial volume index (LAVI) and right ventricular basal diameter (RVD1) also showed a similar trend. The left ventricular internal diameter (LVID) in both systole and diastole increased progressively from the first to the third trimesters, but the increase was only statistically significant between the third trimester (T3) and the first trimester (T1). The right atrial diameter (RAD) and right atrial volume (RAV) also increased progressively from the first to the third trimesters, but the increase was only statistically significant between the third trimester (T3) and the first trimester (T1).

CONCLUSION

Changes were noticed in the cardiac chamber sizes during pregnancy. However, this reversed back to levels similar to the first trimester during the postpartum period. To aid in the early detection and treatment of cardiovascular disorders in pregnancy, screening of apparently healthy pregnant women who later developed complaints is advised as cardiovascular changes could be significant during pregnancy.

Model for End Stage Liver Disease (MELD) Score: A Tool for Prognosis and Prediction of Mortality in Patients With Decompensated Liver Cirrhosis

BACKGROUND

Decompensated liver disease has become a common occurrence in medical wards. It has become the third most common cause of death in medical wards. This high mortality rate has become a matter of concern. It is important that a reliable scoring system helps to stratify patients with liver cirrhosis who will require liver transplantation.

OBJECTIVE

To determine the value of the Model for End-Stage Liver Disease (MELD) score in assessing the mortality of patients with decompensated liver cirrhosis over one month period (30 days).

METHODS AND MATERIALS

A longitudinal study was conducted. A total of 110 patients diagnosed with decompensated liver cirrhosis were recruited from the gastroenterology clinic and medical wards of the University of Benin Teaching Hospital (UBTH), Benin City. The patients were recruited consecutively and met the inclusion criteria for the study. Demographic data, history, clinical, biochemical, ultrasonographic, and liver biopsy findings were evaluated in the patients who participated in this study.  Results: The mean age of the patients was 57 ± 11.06 years. Out of the 110 study participants, a 2.9:1 male-to-female ratio was appreciated in the patient population, with a total of 82 males and 28 females. Multiple logistic regression analysis identified MELD scores as an independent predictor of mortality in the studied patients. Predictive values of the MELD score for 1-month mortality which was analyzed using the receiver operating characteristic (ROC) curves showed that the MELD score had a sensitivity of 72.2% and positive predictive value of 93.6% with an area under the curve of 0.926 for all-cause mortality among decompensated liver cirrhosis patients.

CONCLUSION

MELD score is a good predictor of mortality among patients with decompensated liver cirrhosis over a 1-month (30 days) period.

Echocardiographic Correlates of Left Atrial Function Index Among Hypertensive Heart Failure Patients: A Cross-Sectional Study

Background Heart failure contributes to the global burden of cardiovascular diseases, with hypertensive heart failure affecting individuals in their productive age group and leading to high economic losses and disability-adjusted life years. The left atrium, on the other hand, contributes significantly to left ventricular filling in heart failure patients, and the left atrial function index is an excellent tool for assessing left atrial function among heart failure patients. The study aimed to evaluate some parameters of systolic and diastolic function as correlates and potential predictors of the left atrial function index among hypertensive heart failure cohorts. Materials and methods The study was conducted at Delta State University Teaching Hospital, Oghara. Eighty (80) patients with hypertensive heart failure who met the inclusion criteria were enrolled in the cardiology outpatient clinics. The left atrial function index was calculated using the following formula: LAFI = (LAEF x LVOT-VTI)/LAESVI. (LAFI = left atrial function index; LAEF = left atrial emptying fraction; LAESVI = left atrial end-systolic volume index; LVOTVTI = outflow tract velocity time integral). The data were analysed using IBM Statistical Product and Service Solution Version 22. Relationships between variables were determined using analysis of variance, Pearson correlation, and multiple linear regressions. Significance was assessed at p<0.05. Result It was discovered that the left atrial function index correlated with ejection fraction (r = 0.616, p = 0.001), fractional shortening (r = 0.462, p = 0.001), and the ratio of early transmitral flow to early myocardial contractility, E/E' (r = -0.522, p = 0.001). However, there was no correlation with stroke volume (r = 0.38, p = 0.11); the ratio of early transmitral flow to late transmitral flow, E/A (r = -0.10, p = 0.11); isovolumetric relaxation time, IVRT (r = -0.171, p = 0.11); and tricuspid annular plane systolic excursion, TAPSE (r = 0.185, p = 0.10). Of the variables that correlated with left atrial function index, left ventricular ejection fraction and the ratio of early transmitral flow to early myocardial contractility (E/E') were found to be independent predictors of left atrial function index. Conclusion Left ventricular ejection fraction and the ratio of early transmitral flow to early myocardial contractility reflect changes in the left atrial function index, and as such, they should be used as surrogates for its assessment, especially in low- and medium-income countries where left atrial function index estimation is not routinely done.