Echocardiographic Assessment of Structural and Hemodynamic Changes in Hypertension-Related Pregnancy

다국어 초록 (Multilingual Abstract)

Background: Pregnancy induces dramatic cardiovascular changes in order to meet the increasing metabolic needs. Adaptive change of left ventricle (LV) might be modified in pregnancy complicated by hypertension.
Methods: Data from 193 consecutive pregnant women were analyzed. Clinical and echocardiographic data were compared in normotensive and hypertensive women.
Results: Significantly higher LV mass indexed by height was observed in hypertensive women compared with normotensive women (84 ± 21 g/m vs. 97 ± 20 g/m, p = 0.001). Diastolic function measured by the ratio of peak velocity of early diastolic transmitral blood flow to early diastolic mitral annular velocity was impaired in hypertensive women (11.0 ± 3.0 vs. 9.2 ± 2.5, p < 0.001). Such change was more prominent in women with gestational hypertension (GH) than those with chronic hypertension (CH). Heavy maternal weight was an independent factor associated with LV hypertrophy (LVH) in both normotensive and hypertensive women. Overt eccentric LVH was more frequent than concentric remodeling/hypertrophy (24% vs. 8.4%) in GH, while the opposite result was observed in CH (14% vs. 23%).
Conclusion: Hypertensive pregnancy is associated with significant LVH and diastolic dysfunction. CH seems to induce different LV remodeling pattern from GH. Heavy maternal weight during pregnancy might intensify the unfavorable remodeling of LV, particularly in hypertensive pregnancy.

참고문헌 (Reference)

1 Leddy MA, "The impact of maternal obesity on maternal and fetal health" 1 : 170-178, 2008

2 Simmons LA, "Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy" 283 : H1627-H1633, 2002

3 Nagueh SF, "Recommendations for the evaluation of left ventricular diastolic function by echocardiography" 22 : 107-133, 2009

4 Lang RM, "Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology" 18 : 1440-1463, 2005

5 Chaiworapongsa T, "Pre-eclampsia part 1: current understanding of its pathophysiology" 10 : 466-480, 2014

6 Ganau A, "Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension" 19 : 1550-1558, 1992

7 Easterling TR, "Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study" 76 : 1061-1069, 1990

8 Ghi T, "Maternal cardiac evaluation during uncomplicated twin pregnancy with emphasis on the diastolic function" 213 : 376-, 2015

9 Cho KI, "Impact of gestational hypertension on left ventricular function and geometric pattern" 75 : 1170-1176, 2011

10 Rudski LG, "Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography" 23 : 685-713, 2010

11 Geva T, "Effects of physiologic load of pregnancy on left ventricular contractility and remodeling" 133 : 53-59, 1997

12 Katz R, "Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects" 58 (58): 434-441, 1978

13 Devereux RB, "Echocardiographic assessment of left ventricular hypertrophy:comparison to necropsy findings" 57 : 450-458, 1986

14 Regitz-Zagrosek V, "ESC Guidelines on the management of cardiovascular diseases during pregnancy:the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC)" European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM) 32 : 3147-3197, 2011

15 Zanati Bazan SG, "Disproportionate pregnancy-induced myocardial hypertrophy in women with essential hypertension" 26 : 816-821, 2013

16 Gant NF, "Control of vascular responsiveness during human pregnancy" 18 : 253-258, 1980

17 Warnes CA, "Braunwald’s heart disease: a textbook of cardiovascular medicine" Elsevier Saunders 1755-1770, 2014

18 Gant NF, "A study of angiotensin II pressor response throughout primigravid pregnancy" 52 : 2682-2689, 1973