The use of echocardiography to identify acute and chronic changes in left ventricular function in hypertensive disorder of pregnancy.

Abstract

Background: Hypertensive disorders of pregnancy, including preeclampsia, are common in socioeconomic vulnerable populations worldwide. Approximately one third of women who have those disorders will maintain with hypertension, after pregnancy. This work aimed to determine the prevalence of hypertensive disorder of pregnancy in Natal, Brazil, and to use echocardiography to study cardiac function: (1) during pregnancy, and (2) at post partum in those who developed severe preeclampsia.

Methods: A prospective study after the 7th week of gestation (n = 107) and a cross-sectional study of preeclampsia cases (n = 18) were performed in Natal, Brazil. Data included clinical history, weight, height, age, and transthoracic echocardiogram. Descriptive and exploratory, paired and unpaired Student t-tests, univariate and logistic regression analyses were performed.

Results: Among the 87 women who were fully studied prospectively, age varied between 15.2 - 43.2 years (28.1 ± 6.3) and 9.2% of participants developed hypertension. Notably, 61 (70.1%) had a high body mass index (BMI) of > 25 kg/m². There was myocardial hypertrophy or left ventricular remodeling in 12 subjects (13.8%); ejection fraction under 50% in 4 subjects (4.6%) and echocardiographic evidence of reduced left ventricular global longitudinal strain in 6 (6.9%). Women who developed hypertension had higher BMIs and larger left ventricular mass index. Post-partum women who had severe preeclampsia showed increase in the mean left ventricle relative wall thickness (p = 0.0167) and mean left ventricular isovolumic relaxation time (p = 0.0004) after a mean of a month post-delivery.

Conclusions: There is high prevalence of hypertensive disorder of pregnancy in underprivileged women from Natal, Brazil. Transthoracic echocardiography can identify early ventricular dysfunction in pre- and post-pregnancy and it may be a useful tool to guide in therapeutic strategies to prevent complications.