J Cardiovasc Ultrasound.  2016 Mar;24(1):28-34. 10.4250/jcu.2016.24.1.28.

Echocardiographic Assessment of Structural and Hemodynamic Changes in Hypertension-Related Pregnancy

• Kim MJ
• Seo J
• Cho KI
• Yoon SJ
• Choi JH
• Shin MS

• KMID: 2160992
• DOI: http://doi.org/10.4250/jcu.2016.24.1.28

Abstract

BACKGROUND
Pregnancy induces dramatic cardiovascular changes in order to meet the increasing metabolic needs. Adaptive change of left ventricle (LV) might be modified in pregnancy complicated by hypertension.
METHODS
Data from 193 consecutive pregnant women were analyzed. Clinical and echocardiographic data were compared in normotensive and hypertensive women.
RESULTS
Significantly higher LV mass indexed by height was observed in hypertensive women compared with normotensive women (84 ± 21 g/m vs. 97 ± 20 g/m, p = 0.001). Diastolic function measured by the ratio of peak velocity of early diastolic transmitral blood flow to early diastolic mitral annular velocity was impaired in hypertensive women (11.0 ± 3.0 vs. 9.2 ± 2.5, p < 0.001). Such change was more prominent in women with gestational hypertension (GH) than those with chronic hypertension (CH). Heavy maternal weight was an independent factor associated with LV hypertrophy (LVH) in both normotensive and hypertensive women. Overt eccentric LVH was more frequent than concentric remodeling/hypertrophy (24% vs. 8.4%) in GH, while the opposite result was observed in CH (14% vs. 23%).
CONCLUSION
Hypertensive pregnancy is associated with significant LVH and diastolic dysfunction. CH seems to induce different LV remodeling pattern from GH. Heavy maternal weight during pregnancy might intensify the unfavorable remodeling of LV, particularly in hypertensive pregnancy.

Keyword

Echocardiography; Hypertension; Pregnancy

MeSH Terms

Echocardiography*
Female
Heart Ventricles
Hemodynamics*
Humans
Hypertension
Hypertension, Pregnancy-Induced
Hypertrophy
Pregnancy*
Pregnant Women

Figure

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  Fig. 1 Effects of hypertension on left ventricular (LV) mass and diastolic function. Hypertensive women show high LV mass index (A) and diastolic function index of E/e' ratio (B) compared with normotensive women in both middle and late trimester of pregnancy. Normotensive: normotensive women, Hypertensive: hypertensive women, E: early diastolic transmitral blood flow velocity, e': early diastolic mitral annular velocity.

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  Fig. 2 Effects of body mass index on left ventricular (LV) mass in second (A) and third (B) trimester of pregnancy. Normotensive: normotensive women, Hypertensive: hypertensive women.

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  Fig. 3 Comparison of left ventricular (LV) mass (A) and diastolic function (B) in normotensive women, women with gestational hypertension (GH) and chronic hypertension (CH). *P < 0.05, †P < 0.01. E: early diastolic transmitral blood flow velocity, e': early diastolic mitral annular velocity, NS: not significant.

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  Fig. 4 Left ventricular geometry at the third trimester in normotensive women, women with gestational hypertension (GH) and women with chronic hypertension (CH). Eccentric left ventricular hypertrophy is more frequent in women with GH while concentric hypertrophy/remodeling is more frequent in those with CH.

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