Left ventricular remodeling and diastolic function in chronic hypertensive pregnant women

Hypertension during pregnancy is a problem that impacts maternal morbidity and mortality. Dyspnea and edema are common symptoms, often secondary to physiological changes, but may raise doubts as to ventricular dysfunction.

Objective: To evaluate the ventricular geometry pattern and diastolic function in chronic hypertensive pregnant women (HPW).

Methods: Prospective, cross-sectional study on 62 pregnant women over a 29-month period, from March 2009 to July 2011, in Brazil was done. Thirty-one HPWs and 31 normotensive pregnant women (NPW) underwent clinical and cardiovascular evaluations, and were subjected to transthoracic echocardiogram.

Results: LV mass (HPW: 220.9 ± 43.3 vs. NPW: 192.9 ± 39.8 g, p = 0.01), posterior wall thickness (HPW: 9.9 ± 1.1 vs. NPW: 9.2 ± 0.9 mm, p = 0.005), mitral flow A wave velocity (HPW: 0.60 ± 0.16 vs. NPW: 0.52 ± 0.10 m/s, p = 0.02), tissue Doppler A' wave velocity (HPW: 10 ± 2 vs. NPW: 8.9 ± 1cm/s, p=0.02), and E/E' ratio (HPW: 6.8 ± 2.2 vs. NPW: 5.5 ± 1.6, p = 0.01) were higher in HPWs. Septal and lateral walls E' wave velocities (HPW: 13 ± 2 vs. NPW: 15 ± 3 cm/s, p=0.001), and E'/A' ratio (HPW: 1.26 ± 0.38 vs. NPW: 1.77 ± 0.49, p = 0.00003) were lower in HPWs. There was a positive linear correlation between body mass index (BMI) and ventricular mass, A wave, systolic, diastolic blood pressures, and a negative correlation between BMI, E' wave and E'/A' ratio.

Conclusion: Ventricular remodeling showed a direct relationship with body weight, and both groups showed a predominant pattern of eccentric ventricular hypertrophy. The LV diastolic function was abnormal in HPWs.