Pregnancy related cardiac remodeling in patients with and without hypertension -preliminary results

Abstract Introduciton We present initial echocardiographic results of a study aimed at evaluating cardiovascular system adaptation depending on development of gestational hypertension and preclampsia. Purpose The purpose of the study was to analyze the morphological and functional changes in the heart during pregnancy and postpartum period in women with and without hypertension. Our hypothesis was that in women with hypertension diastolic function abnormalities and lower global longitudinal strain will be observed during pregnancy. Methods Into the study we recruited 150 pregnant women with hypertensive disorders of pregnancy. Each women underwent 2 echocardiographic examinations -one during pregnancy around 30th week of pregnancy and one over six months postpartum. Additionally results of gestational ultrasound and blood tests were analyzed. Heretofore follow up data including the postpartum echo is available for 27 participants. For statistical analysis Statistica 13 was used. Results The mean age was 35.9 years (±4.6). The echo was performed at the 28.7 (±5.3) week of pregnancy, the control echo at 7.3 (±3.2) months postpartum. 17 women did not have any form of hypertension, 6 had hypertension diagnosed prior to pregnancy and 4 had gestational hypertension. During pregnancy the unadjusted to body surface area size of left atrium (LA diameter 35vs 37mm, p=0.001) left ventricle (46vs 47mm, p=0.04) and right ventricle (27vs 28mm, p=0.02) were larger compared to postpartum. Indexed left atrial volume was similar (30.9 vs 28.5ml/m2, p=0.38). There was a significant difference in the thickness of intraventricle septum (8.2 vs 7.5mm, p=0.015) but not posterior wall (7.7 vs 7.3mm, p=0.2). Diastolic parameters (E/A, E/E’avg) were similar during pregnancy and postpartum. Left ventricular ejection fraction was higher during pregnancy (65% vs 64%, p=0.003) but global longitudinal strain was lower (-23.4 vs -24.3%, p=0.04) comparing to postpartum period. Comparison of differences in echocardiographic parameters during and post pregnancy between women with and without hypertension reveled significant differences in left ventricle diameter (3.1 vs 0.4mm, p=0.04) and motion velocities of medial and lateral parts of mitral annulus (E’med -1.7 vs 0.68cm/s, p=0.02; E’lat -3.29 vs -0.15, p=0.01). Conclusions To conclude, presented preliminary results show that in women with hypertensive disorders of pregnancy the increase in left ventricular size is larger during pregnancy. There are also some differences in diastolic function - motion velocities changes of medial and lateral parts of mitral annulus are greater in women with hypertensive disorders of pregnancy.