Myocardial Mechanics in Hypertensive Disorders of Pregnancy: a Systematic Review and Meta-Analysis

Abstract

Global longitudinal strain (GLS) is becoming routinely used to direct the medical management of various cardiac diseases, but its application in pregnancy is unclear. Our objective was to perform a meta-analysis and pool multiple study data to consolidate the evidence base for the role of GLS in the assessment of women with hypertensive disorders of pregnancy (HDP). Electronic database searches were performed in PubMed/Medline and EMBASE for research articles reporting GLS in pregnancies complicated by HDP and normotensive pregnancies that have been published up to September 2021. The meta-analysis included 17 studies with a pooled sample size of 1723 participants, which included 951 women with HDP, of which 680 were preeclamptic, and 772 controls. The primary random-effects pooled analysis demonstrated a statistically significant weighted mean difference in GLS between the HDP and control group (mean difference: 3.08% [CI, 2.33–3.82], P <0.001). When analyzed including only preeclamptic studies, there was also a statistically significant mean difference (mean difference: 2.98% [95% CI, 1.97–3.99], P <0.001). This meta-analysis demonstrates that HDP is associated with greater cardiac maladaptation, evidenced by a significantly reduced GLS compared with normal pregnancy. Echocardiography should be considered as a screening tool in women with HDP to enable early cardiovascular risk prevention through national initiatives.

Peripartum and Long-Term Maternal Cardiovascular Health After Preeclampsia

“…14 In a multicenter observational study of 321 women with preterm preeclampsia, 10% of women had a left ventricle ejection fraction <55% or diastolic dysfunction at 6 months postpartum. 5 Melchiorre et al 15 demonstrated in preeclampsia patients with normal blood pressure (BP) at 1 year after delivery that those with moderate-severe echocardiographic left ventricle anomalies were more likely to develop hypertension at 2 years postpartum (50% risk) in comparison to those with normal or mild left ventricle alterations (3.5% risk). Women with a history of preeclampsia have altered cardiac structure and evidence of diastolic and myocardial dysfunction in the first years after delivery, which may then translate to a trend toward long-term CVD.…”

“…Maternal echocardiography can detect HDP-associated increased left ventricle mass, cardiac remodeling, and diastolic dysfunction. 5‚10–12 Patients with severe or preterm preeclampsia, particularly if they present with dyspnea or signs of volume overload, would probably benefit from an echocardiographic evaluation in the peripartum period to evaluate systodiastolic function. HDP is also the major risk factor for peripartum cardiomyopathy, where women with peripartum cardiomyopathy and preeclampsia exhibit more severe symptoms and signs of heart failure compared to peripartum cardiomyopathy without hypertension.…”

Hypertensive disorders of pregnancy and long‐term cardiovascular health: FIGO Best Practice Advice

“…Failure to achieve normal cardiovascular adaptation is associated with development of HDP 12,13 . The maternal hemodynamic alterations associated with HDP are likely to be the consequence of pre‐existing maternal cardiovascular impairment and/or chronic changes in cardiovascular load during pregnancy 14 .…”

“…Failure to achieve normal cardiovascular adaptation is associated with development of HDP. 12,13 The maternal hemodynamic alterations associated with HDP are likely to be the consequence of preexisting maternal cardiovascular impairment and/or chronic changes in cardiovascular load during pregnancy. 14 These cardiovascular changes, which correlate with disease severity, [15][16][17][18][19][20] are initiated from the first trimester 21 and can be detected before the condition becomes clinically apparent.…”

Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society

“…If echocardiography is performed, the focus should be on the assessment of concentric hypertrophy, left atrial dilatation [ 47 ] and diastolic dysfunction [ 48 ]. Left ventricular ejection fraction does not appear to be affected by gestational hypertension [ 48 , 49 ], although global longitudinal strain has been shown to be reduced [ 50 ].…”