Dimensions of the left ventricle, atrium, and aortic root in pregnancy-induced hypertension

Abstract

Chronic hypertension induces changes in the structure of the left ventricle, atrium, and aortic root. However, the effects of transient hypertension are unclear. Pregnancy-induced hypertension (PIH) offers a natural and spontaneous model of this condition. Using M-mode echocardiography, we studied 95 consecutive patients with PIH, who were compared with 83 normal pregnant women (NPW). We evaluated diastolic diameter (DD), systolic diameter (SD), septal thickness (ST), posterior wall thickness (PWT), shortening fraction (SF), relative wall thickness (RWT), left ventricular mass index (LVMI), left atrial dimension (LAD), and aortic root dimension (ARD). Patients with PIH had higher ST (9.98 +/- 1.47 mm v 8.96 +/- 1.43 mm, P < .000), PWT (9.28 +/- 1.48 mm v 8.55 +/- 1.35 mm, P < .000), LVMI (107.65 +/- 27.87 g/m2 v 92.38 +/- 17.99 g/m2, P < .000), and RWT (0.406 +/- 0.06 v 0.377 +/- 0.06 mm, P < .002). There were no significant differences in DD, SD, SF, LAD, and ARD. In conclusion, PIH increases the LVMI due to an increase in the ST and PWT. The dimensions of the left ventricle, left atrium, and aortic root do not change.

Maternal total vascular resistance and concentric geometry: a key to identify uncomplicated gestational hypertension

“…3,4,9,10,[14][15][16][17][18][19][20][21]33 On the other hand, there is still debate about the haemodynamic model of isolated gestational hypertension and the state of hypertension that precedes preeclampsia. [11][12][13]15,33,34 In particular, the studies from Bosio et al 33 and Easterling et al 34 have shown that the preclinical phase of pre-eclampsia is characterised by a low TVR and high CO. In the series of Easterling et al, 34 women maintained this haemodynamic characteristic when pre-eclampsia developed, whereas the study from Bosio et al 33 showed a reduction in CO and an increase of peripheral resistance in established preeclampsia.…”

“…All participants underwent uterine artery colour Doppler examination with the calculation of the resistance index (RI) as previously described. [11][12][13][14][15] A mean RI of both uterine arteries >0.6 was considered abnormal.…”

“…In the search for factors that can predict adverse outcomes (abnormal uterine Doppler, serum levels of inhibin, etc), attention has been focused on uterine cardiovascular parameters. [5][6][7][8] However, many reports have shown that the cardiovascular adaptation to pregnancy is altered during complicated pregnancies [9][10][11][12][13][14][15][16][17][18][19][20][21] and that altered geometry of the left ventricle in gestational hypertension is associated with adverse pregnancy outcomes. 15 Women with gestational hypertension who subsequently develop complications also showed some functional differences compared with uncomplicated women with gestational hypertension, in particular, higher total vascular resistance (TVR).…”

Non-Dipping Patten of Blood Pressure and Gestational Hypertension

“…Mentioned hemodynamic changes affect the function and morphology of the LV. According to the literature data, which are unfortunately, due to the specificity of the problem, still scarce and done in a small number of cases, there is mainly a change of the diastolic function of LV in GH, while the data on the change of the systolic function are fewer and more controversial [76][77][78][79].…”

“…In hypertensive pregnancies, due to increased after-load and peripheral vascular resistance, hemodynamics is further complicated. There is a more pronounced decrease in the E/A ratio, prolongation of IVRT and DTE, changes of volume and dimensions of the LA [77][78][79][80][81]. In normotensive pregnant women, increased preload and decreased afterload lead to improved discharge of the LV during systole and reduction of end-systolic pressure.…”