Echocardiographic Study of Cardiac Morphological and Functional Changes before and after Parturition in Pregnancy‐Induced Hypertension

Abstract

Purpose: To investigate the cardiac morphological and functional changes by echocardiography, before and after parturition in patients with pregnancy-induced hypertension (PIH). Methods: The parameters related to cardiac morphology and left ventricular diastolic and systolic functions were compared before and after parturition in 32 patients with PIH and 24 normal pregnant (NP) women. Results: Compared with NP women, the PIH patients had greater diameters of left atrium and left ventricle in end-diastole (LAd: 38.9 ± 4.5 vs 34.6 ± 4.4 mm, P = 0.0015; LVEDd: 51.2 ± 5.8 vs 47.1 ± 4.2 mm, P = 0.036) and lower E/A (1.2 ± 0.2 vs 1.4 ± 0.2, P = 0.009) and greater fractional shortening (FS) (39.8 ± 6.5% vs 37.1 ± 6.9%, P = 0.042) and ejection fraction (EF) (0.72 ± 0.07 vs 0.66 ± 0.08, P = 0.040). Pericardial effusion (PE) occurred in 31.3% and 16.7% of PIH and NP, respectively. The LAd and LVEDd in 70% and 47% patients with PIH resolved and PE disappeared in 80% of PIH patients postpartum. E/A ratio in PIH significantly increased after parturition, while the two patients with cardiac systolic dysfunction did not improve very much. Conclusions: Compared with normal pregnancy, the most significant cardiac morphological changes in PIH are the greater diameters of left atrium and left ventricle, thicker inter-ventricular septum (IVS), more PE, impaired left ventricular diastolic function, and increased systolic function. The PE could disappear in PIH and about half of other abnormalities could recover to be the level of normal pregnancy postpartum within 2 months. (ECHOCARDIOGRAPHY, Volume 23, March 2006) pregnancy-induced hypertension, cardiac morphology, echocardiography, cardiac function, postpartum

Echocardiographic Structure and Function in Hypertensive Disorders of Pregnancy

“…33,35,38,40,41,45,50 Hypertrophy in preeclampsia tends to be of the concentric type 50 and has been shown in preterm 33,40,46 and term preeclampsia. 41,45,46,55 In 1 study, concentric LV remodeling was demonstrated at 20 to 23 weeks of gestation in 33% of women who subsequently developed preeclampsia. 27 In women who progressed to preeclampsia from GH, 27% had abnormal LV structure and function at the time of echocardiography.…”

“…3,17,58,60,61 A greater reduction in E/A has been shown in GH than in pregnancy unaffected by hypertension. 24,35,47,48,55 Diastolic function is also impaired in preeclampsia, 40,46,53 where the usual reduction in E/A is exaggerated.…”

“…49,52 LV/left atrial diameters were increased in GH compared with normotensive controls. 38,55 LV remodeling is more common in preeclampsia than in normotensive pregnant women in the third trimester, 56 with numerous studies confirming increased LV mass in preeclampsia. 33,35,38,40,41,45,50 Hypertrophy in preeclampsia tends to be of the concentric type 50 and has been shown in preterm 33,40,46 and term preeclampsia.…”

“…3,17,58,60,61 A greater reduction in E/A has been shown in GH than in pregnancy unaffected by hypertension. 24,35,47,48,55 Diastolic function is also impaired in preeclampsia, 40,46,53 where the usual reduction in E/A is exaggerated.33,40,46,55 The ratio of early diastolic mitral inflow velocity:early diastolic mitral annular velocity (E/e′) was significantly higher in women with preeclampsia in 5 studies, suggesting higher LV filling pressures. 27,38,40,53,57 Interestingly E/e′ was shown to be significantly higher in an early-onset preeclampsia subgroup compared with a late-onset subgroup.…”

“…[22][23][24] The majority of studies (n=20) were of women with preeclampsia. 23,[26][27][28][29][30]33,38,[40][41][42]44,[50][51][52][53][55][56][57] There were 9 studies assessing GH only 24,32,35,37,39,43,48,49,54 and 7 studies evaluating both GH and preeclampsia. 22,25,31,34,36,43,45 All investigators recruited women during antenatal visits to hospital.…”