Left ventricular function impairment in pregnancy-induced hypertension

Abstract

The changes induced by transient hypertension on cardiac structure and function are unclear. Pregnancy-induced hypertension offers a natural and spontaneous model of this condition. To assess the potential of echocardiographic Doppler to unmask left ventricular function impairment, we studied 28 women aged 26.4 +/- 7.2 years with pregnancy-induced hypertension defined as blood pressure higher than 140/90 mm Hg in the third trimester of pregnancy without a history of hypertension. Twenty normal pregnant women, aged 27.5 +/- 6.4 years, were the controls. Left ventricular diastolic diameter, fractional shortening, 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 Doppler 2 to 4 days postpartum. There were statistically significant differences between groups in the following parameters: E/A ratio: 1.3 +/- 0.3 in pregnancy-induced hypertension v 1.5 +/- 0.3 in normal pregnant women (P < .05), IRT: 104 +/- 14 msec v 84 +/- 7 msec (P < .000), and the Tei index: 0.51 +/- 0.15 v 0.35 +/- 0.04 (P < .00), respectively. According to this data pregnancy-induced hypertension evaluated 2 to 4 days after delivery showed left ventricular dysfunction, mainly diastolic. The IRT and the Tei index are the most useful echocardiographic parameters to unmask left ventricular dysfunction in pregnancy-induced hypertension.

Clinical Characteristics of Peripartum Cardiomyopathy in the United States

“…Although one can argue that LV dysfunction is not truly "idiopathic" in the setting of severe hypertension, chronic hypertension is not likely to cause marked LV systolic dysfunction in young women, and hypertensive pulmonary edema is due mostly to exacerbation of diastolic dysfunction by hypertension, not to transient systolic dysfunction (31). In fact, assessment of systolic LV function in pregnant women with hypertension by a number of investigators has shown it to be preserved (32)(33)(34). Preeclampsia can also present with signs and symptoms of HF, but systolic function is usually preserved or even improved (33,(35)(36)(37).…”

Left Ventricular Function in Gestational Hypertension: Serial Echocardiographic Study

“…[1][2][3]5 lV mass Pregnancy is considered predominantly as a volume overload state. This volume overload may be considered as a stimulus for LV hypertrophy.…”

“…[1][2][3][4][5] However, most of these studies have compared single measurements, [1][2][3][4] whereas only one study has serially evaluated changes of these parameters throughout the pregnancy and after delivery. 5 Also, the results are conflicting.…”

Placental ischemia and cardiovascular dysfunction in preeclampsia and beyond: making the connections

“…These adaptations, which have been reported in both humans and rats, include increased plasma volume, stroke volume (SV), left ventricular (LV) hypertrophy, decreased total peripheral resistance (TPR) and moderate insulin resistance [9-11]. By contrast, pregnancies affected by PE are often characterized by increased uterine vascular resistance (and reduced uteroplacental blood flow), increased TPR and mean arterial pressure (MAP), diastolic dysfunction indicated by a decreased early-to-late transmitral flow velocity ratio (E/A ratio), a blunting of the normal plasma volume expansion and decreased SV [12-14]. …”