Impact of gestational hypertension on left ventricular function and geometric pattern

BACKGROUND

The effect of gestational hypertension on left ventricular (LV) function in previously normotensive young women has not been evaluated.

METHODS AND RESULTS

A total of 106 gestational hypertensive women (GHW, 32.3 ± 4.2 years) and 93 normotensive pregnant women (NPW, 30.2 ± 4.4 years) were enrolled. Transthoracic echocardiography, including 2-dimensional strain echocardiography, was done and myocardial performance (Tei index), LV mass index (LVMI), and relative wall thickness (RWT) were analyzed. GHW had significantly increased wall thickness (interventricular septum, 9.5 ± 0.9 mm vs. 8.8 ± 1.0 mm, P < 0.001; posterior wall, 9.0 ± 1.1 mm vs. 8.5 ± 1.1 mm, P = 0.007; and RWT, 0.39 ± 0.06 vs. 0.35 ± 0.05, P = 0.02), higher LVMI (95.6 ± 17.3g/m² vs. 86.1 ± 14.5g/m², P = 0.03), longer isovolumetric relaxation time (117.7 ± 18.2 ms vs. 82.3 ± 12.6 ms, P = 0.003), lower E/A ratio (1.00 ± 0.29 vs. 1.27 ± 0.33, P = 0.002), and higher Tei index (0.48 ± 0.23 vs. 0.33 ± 0.13, P = 0.003) compared to NPW. Global longitudinal LV strain, representing LV systolic function, was also significantly reduced in GHW compared with NPW (-17.6 ± 2.95% vs. -21.2 ± 2.14%, P = 0.02). A total of 62% of GHW (n = 66) had abnormal geometry, of whom, 42 (40%) had eccentric hypertrophy (EH). A total of 93% of NPW (n = 86) had normal geometry, and only 7 NPW (7%) had abnormal geometry.

CONCLUSIONS

GHW had aggravated diastolic and longitudinal systolic dysfunction. GHW had increased LVMI with the abnormal geometric pattern of EH. The reversibility of these morphological and functional impairments after delivery needs to be clarified.