Peripartum echocardiographic changes in women with hypertensive disorders of pregnancy.

Journal article


Giorgione, V., O'Driscoll, J, Coutinho, C., Di Fabrizio, C, Sharma, R, Khalil, A. and Thilaganathan, B. 2021. Peripartum echocardiographic changes in women with hypertensive disorders of pregnancy. Ultrasound in Obstetrics & Gynecology. https://doi.org/10.1002/uog.23745
AuthorsGiorgione, V., O'Driscoll, J, Coutinho, C., Di Fabrizio, C, Sharma, R, Khalil, A. and Thilaganathan, B.
AbstractWomen 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. 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. 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/m vs 77.9 ±15.4 g/m , 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. 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. [Abstract copyright: This article is protected by copyright. All rights reserved.]
Keywordspregnancy; echocardiography; left ventricle remodelling; preeclampsia; hypertensive disorders of pregnancy
Year2021
JournalUltrasound in Obstetrics & Gynecology
PublisherWiley
ISSN1469-0705
Digital Object Identifier (DOI)https://doi.org/10.1002/uog.23745
Official URLhttps://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.23745
Publication dates
Online26 Jul 2021
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Deposited30 Jul 2021
Accepted19 Jul 2021
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Open
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