Echocardiographic Differences In Women Across Subtypes of Hypertensive Disorders of Pregnancy

Overview

Journal JACC Adv

Specialty Cardiology & Vascular Diseases

Date 2024 Jun 28

PMID 38939814

Authors

Laith Alhuneafat

Nada Alrifai

Richard Amoateng

Andreas Kyvernitakis

Ahmad Jabri

Mahathi Indaram

Mark Doyle

Brent A Williams

Indu G Poornima

Affiliations

Soon will be listed here.

Abstract

Background: Hypertensive disorders of pregnancy (HDP) can be classified into gestational hypertension, preeclampsia (PRE), and chronic hypertension with superimposed preeclampsia (SPE).

Objectives: The purpose of this study was to retrospectively examine the echocardiographic differences in biventricular structure and function in 3 HDP groups of women in comparison to normotensive pregnant controls.

Methods: Women with an echocardiogram during or within the first year of pregnancy were identified within our integrated health network. Exclusion criteria included age <18 years, diagnosis of pulmonary embolism, malignancy, autoimmune disease, and structural heart disease.

Results: We identified a total of 706 subjects (cases: n = 427, normotensive controls: n = 279). Cases were divided into 3 groups: gestational hypertension (n = 57), PRE (n = 291), and SPE (n = 79). In adjusted analyses, echocardiographic parameters demonstrated a graded difference in left ventricular (LV) mass index, relative wall thickness, mitral inflow E, mitral inflow A, septal e', lateral e', E/e', left atrial volume index, tricuspid velocity, and lateral e' velocities with the most profound findings noted in the SPE group. Specifically, adjusted LV mass index (adjusted β = 14.45, 95% CI: 9.00-19.90) and E/e' (adjusted β = 2.97, 95% CI: 2.27-3.68) was highest in the SPE group in comparison to controls ( < 0.001).

Conclusions: LV remodeling and diastolic filling abnormalities are more common in HDP and are most evident in SPE and PRE. Echocardiography during or immediately after pregnancy may be useful in these high-risk women to identify these abnormalities. The long-term implications of these echocardiographic abnormalities require further study.

References

Levine L, Lewey J, Koelper N, Downes K, Arany Z, Elovitz M . Persistent cardiac dysfunction on echocardiography in African American women with severe preeclampsia. Pregnancy Hypertens. 2019; 17:127-132. PMC: 6858847. DOI: 10.1016/j.preghy.2019.05.021. View

CHESLEY L . Plasma and red cell volumes during pregnancy. Am J Obstet Gynecol. 1972; 112(3):440-50. DOI: 10.1016/0002-9378(72)90493-0. View

Dennis A, Castro J, Carr C, Simmons S, Permezel M, Royse C . Haemodynamics in women with untreated pre-eclampsia. Anaesthesia. 2012; 67(10):1105-18. DOI: 10.1111/j.1365-2044.2012.07193.x. View

Vaught A, Kovell L, Szymanski L, Mayer S, Seifert S, Vaidya D . Acute Cardiac Effects of Severe Pre-Eclampsia. J Am Coll Cardiol. 2018; 72(1):1-11. PMC: 8136241. DOI: 10.1016/j.jacc.2018.04.048. View

Geva T, Mauer M, Striker L, Kirshon B, Pivarnik J . Effects of physiologic load of pregnancy on left ventricular contractility and remodeling. Am Heart J. 1997; 133(1):53-9. DOI: 10.1016/s0002-8703(97)70247-3. View

Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P . Recommendations for chamber quantification. Eur J Echocardiogr. 2006; 7(2):79-108. DOI: 10.1016/j.euje.2005.12.014. View

Timokhina E, Kuzmina T, Strizhakov A, Pitskhelauri E, Ignatko I, Belousova V . Maternal Cardiac Function after Normal Delivery, Preeclampsia, and Eclampsia: A Prospective Study. J Pregnancy. 2019; 2019:9795765. PMC: 6420982. DOI: 10.1155/2019/9795765. View

Giorgione V, ODriscoll J, Coutinho C, Di Fabrizio C, Sharma R, Khalil A . Peripartum echocardiographic changes in women with hypertensive disorders of pregnancy. Ultrasound Obstet Gynecol. 2021; 59(3):365-370. DOI: 10.1002/uog.23745. View

Krumholz H, Larson M, Levy D . Prognosis of left ventricular geometric patterns in the Framingham Heart Study. J Am Coll Cardiol. 1995; 25(4):879-84. DOI: 10.1016/0735-1097(94)00473-4. View

10.

Brown M, Magee L, Kenny L, Karumanchi S, McCarthy F, Saito S . Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension. 2018; 72(1):24-43. DOI: 10.1161/HYPERTENSIONAHA.117.10803. View

11.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003. View

12.

Melchiorre K, Sharma R, Khalil A, Thilaganathan B . Maternal Cardiovascular Function in Normal Pregnancy: Evidence of Maladaptation to Chronic Volume Overload. Hypertension. 2016; 67(4):754-62. DOI: 10.1161/HYPERTENSIONAHA.115.06667. View

13.

Oshunbade A, Hamid A, Lirette S, Gbadamosi S, Yimer W, Orimoloye O . Hypertensive diseases in pregnancy, cardiac structure and function later in life: Insights from the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Pregnancy Hypertens. 2020; 21:184-190. DOI: 10.1016/j.preghy.2020.05.010. View

14.

Sharp A, Tapp R, Thom S, Francis D, Hughes A, Stanton A . Tissue Doppler E/E' ratio is a powerful predictor of primary cardiac events in a hypertensive population: an ASCOT substudy. Eur Heart J. 2009; 31(6):747-52. DOI: 10.1093/eurheartj/ehp498. View

15.

Kilic D, Guler T, Sevgican C, Atigan A, Kilic O, Kaya D . Severe Preeclampsia is Associated with Functional and Structural Cardiac Alterations: A Case-control Study. Z Geburtshilfe Neonatol. 2021; 226(1):41-47. DOI: 10.1055/a-1403-3585. View

16.

Say L, Chou D, Gemmill A, Tuncalp O, Moller A, Daniels J . Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014; 2(6):e323-33. DOI: 10.1016/S2214-109X(14)70227-X. View

17.

Castleman J, Ganapathy R, Taki F, Lip G, Steeds R, Kotecha D . Echocardiographic Structure and Function in Hypertensive Disorders of Pregnancy: A Systematic Review. Circ Cardiovasc Imaging. 2016; 9(9). DOI: 10.1161/CIRCIMAGING.116.004888. View

18.

Panaitescu A, Syngelaki A, Prodan N, Akolekar R, Nicolaides K . Chronic hypertension and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol. 2017; 50(2):228-235. DOI: 10.1002/uog.17493. View

19.

Sep S, Schreurs M, Bekkers S, Kruse A, Smits L, Peeters L . Early-pregnancy changes in cardiac diastolic function in women with recurrent pre-eclampsia and in previously pre-eclamptic women without recurrent disease. BJOG. 2011; 118(9):1112-9. DOI: 10.1111/j.1471-0528.2011.02951.x. View

20.

Ambrozic J, Brzan Simenc G, Prokselj K, Tul N, Cvijic M, Lucovnik M . Lung and cardiac ultrasound for hemodynamic monitoring of patients with severe pre-eclampsia. Ultrasound Obstet Gynecol. 2016; 49(1):104-109. DOI: 10.1002/uog.17331. View