Prognostic Effect of Left Atrial Function by Three-Dimensional Speckle-Tracking Echocardiography on Adverse Pregnancy Outcomes in Patients With Hypertensive Disorders of Pregnancy: A Preliminary Study

Objective

To evaluate the left atrial function in pregnant women with hypertension versus those with normotension using three-dimensional speckle tracking echocardiography (3D-STE) and investigate the association between left atrial dysfunction and adverse pregnancy outcomes.

Methods

A total of 94 pregnant women registered at the Tiantan Hospital between August 2023 and October 2024 who underwent comprehensive prenatal exams were enrolled. They were divided into three groups according to their blood pressure: gestational hypertension (GH), preeclampsia (PE), and normotensive control groups. The left atrial function was evaluated using two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional speckle tracking echocardiography (3D-STE). Demographic and echocardiographic parameters were analyzed and compared across the three groups. Maternal births were also documented. The primary adverse pregnancy outcomes included iatrogenic preterm delivery, admission to the neonatal intensive care unit, and infants with small for gestational age. The cohort of pregnant women with hypertensive disorders were stratified into two groups based on the occurrence of adverse pregnancy outcomes: those with adverse outcomes and those without. Comparative analyses were performed to evaluate the differences in demographic and echocardiographic parameters between these groups. Subsequently, regression analyses were performed to identify potential prognostic factors.

Results

Pregnant women with GH and PE exhibited increased maximum left atrial volume and decreased left atrial deformation during the reservoir (LASr) and conduit (LAScd) phases compared to those in the control group (p < 0.05). 3D-STE revealed significantly larger left atrial volumes in both the GH and PE groups (p < 0.05), and compared to the control group, the absolute value of LASr, LAScd, left atrial contractile strain (LASct), and the circumferential strain of the left atrial reservoir (LASrc) demonstrated a significant reduction in the GH and PE groups (p < 0.05). Multivariate logistic regression analysis determined the systolic blood pressure and LASr (3D-STE) as independent predictors of adverse pregnancy outcomes. The LASr (3D-STE) predictive cutoff was ≤27%.

Conclusion

3D-STE can detect early reduced left atrial function in patients with hypertensive disorders of pregnancy, and LASr can predict adverse pregnancy outcomes.