Gestational hypertension determines subclinical right ventricular dysfunction as compared to a normotensive pregnant group

Introduction: Gestational hypertension (GHT) and preeclampsia (PE) are associated with a significant short and long term cardiovascular risk, some data indicating a subtle negative effect on left cardiac and vascular function that maintains even after delivery. However, right cardiac structural and functional chan-ges, as compared to normal pregnancy physiological adaptation are scarcely studied.

Objective: Our aim was to assess right cardiac geome-try and function in a group of pregnant women with GHT/PE by comparison to a normotensive control group.

Methods: 58 pregnant women were studied, 31 with GHT/PE (as defined by current guidelines), no cardiovascular or medical history and 27 normotensives as control. Blood pressure, heart rate, and body mass index were recorded. Echocardiographic study used color 2D, spectral and tissue Doppler and 2D speckle tracking. Right heart geometry was assessed by indexed right atrial (RA) maximal volume and right ventricle (RV) basal and mid-diastolic diameters; global func-tion and hemodynamics by pulmonary flow VTI, RV fractional area change (FAC) and RV Tei index; and re-gional RV function by TDI tricuspid annular S, E’and A’wave velocities and free RV wall longitudinal strain.

Results: GHT/PE and control groups were similar in terms of age (32.2 ± 5 vs. 31.7 ± 4), pregnancy weeks (31.3 ± 6 vs. 30.7 ± 4), primi-multiparity status and heart rate (89.1 ± 12 vs. 84.4 ± 10) but hypertensive group had higher pre-pregnancy and actual body mass index (25.8 ± 5 vs. 22.3 ± 2 and 29.7 ± 4 vs. 25.4 ± 2 respectively, both p<0.05). Indexed RV mid-diastolic diameter was higher in GHT/PE group (18.9 ± 7 vs. 14.6 ± 2, p=0.008) but there were no other significant differences in structural parameters or global function and all were in normal range values. As for RV regional function, GHT/PE group showed a decreased E’wave velocity (14.8 ± 3 vs. 17.5 ± 4, p=0.02) and RV free wall longitudinal strain (18.4 ± 7 vs. 25.6 ± 4, p=0.001), in-dicating a subclinical right heart dysfunction.

Conclusions: While right cardiac global function and loading features were almost similar, hypertensi-ve pregnant group showed subtle regional systolic and diastolic dysfunction. Along with left cardiac function, further studies should establish whether this condition is transitory or persistent after delivery, increasing the risk for progression to overt heart failure in these yo-ung female patients.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)