Echocardiographic Assessment of LV Geometric Pattern and Function in Pregnancy-Induced Hypertension

Abstract

Background and Objectives：Chronic hypertension induces changes in the cardiac structure and function; however, the effects of transient hypertension are unclear. Pregnancy-induced hypertension (PIH) offers a natural and spontaneous model of this condition. Subjects and Methods：20 women, aged 30.3±5.1 years, with pregnancy-induced hypertension, defined as a blood pressure higher than 140/90 mmHg in the third trimester of pregnancy, with no prior history of hypertension, were studied. 20 normal pregnant women (NPW), aged 30.9± 3.7 years, were used as the controls. The cardiac chamber dimensions, interventricular septal thickness (IVST), posterior wall thickness (PWT), left ventricular mass index (LVMI), relative wall thickness (RWT), E velocity, A velocity, E/A ratio, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), ejection time (ET) and the combined index of myocardial performance (Tei index=IRT+ICT/ET) were calculated by echocardiography. Subjects were considered to have: normal geometry (NG) if both the LVMI and RWT were normal; concentric hypertrophy (CH) if both were elevated; eccentric hypertrophy (EH) if the LVMI was elevated and the RWT normal; and concentric remodeling (CR) if the LVMI was normal and the RWT elevated. Results： There were significant differences between the 2 groups in the following parameters; IVST: 10.

Assessment of cardiac hemodynamic changes during pregnancy in normal and hypertensive women

“…There were no significant change in LV dimensions and volumes. These changes agree with other studies 10,17,[21][22][23][24][25] .…”

“…A more(significant) increase in A (atrial) mitral velocity; and this is compatible with other results 21,22,25 ; and decrease in E/A ratio as agree with others 21,22,25 was found in untreated hypertensive; give an opinion to the more role of atrial contraction in hypertrophied ventricular muscles of these pregnant. IVSd, PWTd and thus the LVM and LVMI were significantly increased in hypertensive pregnant women that is agree with most studies 10,18,[21][22][23][24] . (Figure 1).…”

“…Mitral E (early) velocity was increased, this proposed that transmitral pressure gradient during early passive filling is greater and reflects alterations in passive cardiac muscles compliance in the hypertrophic ventricle, this non-significant difference in E wave velocity is found also in other studies 21,22 . A more(significant) increase in A (atrial) mitral velocity; and this is compatible with other results 21,22,25 ; and decrease in E/A ratio as agree with others 21,22,25 was found in untreated hypertensive; give an opinion to the more role of atrial contraction in hypertrophied ventricular muscles of these pregnant. IVSd, PWTd and thus the LVM and LVMI were significantly increased in hypertensive pregnant women that is agree with most studies 10,18,[21][22][23][24] .…”

“…Significant increase observed in EF and FS between untreated hypertensive pregnant and normotensive pregnant groups as reported by Dennis et al (2010) 5,18 and Kim et al (2016) 17 ; and this could be explained by increase cardiac inotropy and LVM, while others [21][22][23][24][25] suggested a non-significant changes. LV EF and FS are sensitive to altered loading condition, and this could explain this differences.…”

Impact of Gestational Hypertension on Left Ventricular Function and Geometric Pattern

“…14 According to the present study, GHW had a significant increase in LV mass, a situation that especially reflects an increase in septal and posterior wall thickness without changes in LV diastolic diameter, and these findings were confirmed by our previous study. 15 We considered the mean ± 2SD of LVMI and RWT of NPW as the These differing results may be due to differences in the subjects in terms of age and the duration of pregnancy. The pregnant women in the present study had other hemodynamic modifications that can produce different changes in the structure and function of the left ventricle.…”