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Peripartum echocardiographic changes in women with hypertensive disorders of pregnancy

Giorgione, V; O'Driscoll, J; Coutinho, CM; Di Fabrizio, C; Sharma, R; Khalil, A; Thilaganathan, B (2022) Peripartum echocardiographic changes in women with hypertensive disorders of pregnancy. Ultrasound Obstet Gynecol, 59 (3). pp. 365-370. ISSN 1469-0705 https://doi.org/10.1002/uog.23745
SGUL Authors: Khalil, Asma Thilaganathan, Baskaran

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Abstract

OBJECTIVES: Women with hypertensive disorders of pregnancy (HDP) present with evidence of significant myocardial dysfunction on echocardiographic assessment at the time of diagnosis. Birth not only cures the syndrome of HDP, but is also associated with a reduction in cardiovascular (CV) volume and resistance load in the mother due to the delivery of the fetoplacental unit. The impact of this physiological change on maternal myocardial function in women with HDP has not been systematically evaluated. The aim of this study is to compare echocardiographic findings immediately before and after childbirth in women with HDP. METHODS: In this prospective longitudinal study, 30 women with a diagnosis of HDP underwent two consecutive transthoracic echocardiography (TTE) examinations: the first prepartum and the second in the early postpartum period. Paired comparisons of these assessments were performed. RESULTS: Left ventricular (LV) concentric remodelling or hypertrophy were found in 21 (70%) patients and there were no significant differences in cardiac morphology indices: LV mass index (78.9±16.3 g/m2 vs 77.9 ±15.4 g/m2 , p=0.611) and relative wall thickness (0.45±0.1 vs 0.44±0.1, p=0.453). LV diastolic function did not demonstrate any peripartum variation: left atrial volume (52.40±15.3 vs 50.97±15.6, p=0.433); lateral E' (0.12±0.03 vs 0.12±0.03, p=0.307) and E/E' ratio (7.88±2.19 vs 7.91±1.74, p=0.934). Systolic function indices such as LV ejection fraction (57.5±4.4% vs 56.4±2.1%, p=0.295) and global longitudinal strain (-15.3±2.6% vs -15.1±3.1%, p=0.715) also remained unchanged. CONCLUSIONS: Maternal hemodynamic changes associated with birth did not significantly influence peripartum TTE indices in women with HDP. Suboptimal maternal echocardiographic findings in HDP are likely to be the consequence of chronic pregnancy CV load changes or pre-existing maternal CV impairment. Severity and persistence of myocardial dysfunction into the postpartum period may be related to the long-term maternal CV disease legacy of HDP. This article is protected by copyright. All rights reserved.

Item Type: Article
Additional Information: © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: echocardiography, hypertensive disorders of pregnancy, left ventricle remodelling, preeclampsia, pregnancy, echocardiography, hypertensive disorders of pregnancy, left ventricle remodelling, preeclampsia, pregnancy, Obstetrics & Reproductive Medicine, 1114 Paediatrics and Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
3 March 2022Published
8 February 2022Published Online
19 July 2021Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
765274Horizon 2020http://dx.doi.org/10.13039/501100007601
2019/01280-3Fundação de Amparo à Pesquisa do Estado de São PauloUNSPECIFIED
PubMed ID: 34309939
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/113515
Publisher's version: https://doi.org/10.1002/uog.23745

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