Echocardiographic Assessment of Structural and Functional Cardiac Alterations in Gestational Hypertension and Preeclampsia: A Comparative Cross-Sectional Study

TL;DR

This study uses echocardiography to compare heart changes in pregnant women with gestational hypertension/preeclampsia versus healthy controls, revealing significant structural and functional cardiac differences.

Contribution

The study provides a detailed echocardiographic characterization of cardiac adaptations in gestational hypertension and preeclampsia.

Findings

Hypertensive pregnancies show significant left ventricular dilatation and wall thickening compared to controls.

Diastolic dysfunction and left atrial enlargement are prominent in gestational hypertension and preeclampsia.

Pulmonary artery pressure is elevated in hypertensive pregnancies despite preserved systolic function.

Abstract

Background

Hypertensive disorders of pregnancy (HDP), encompassing gestational hypertension and preeclampsia, are significant cardiovascular complications and leading causes of maternal morbidity and mortality. These conditions involve complex pathophysiological mechanisms extending beyond elevated blood pressure and induce cardiac structural and functional adaptations with potential long-term cardiovascular implications. Contemporary evidence demonstrates that women with hypertensive pregnancy disorders face substantially elevated risks for future cardiovascular disease. This comparative cross-sectional investigation aimed to systematically evaluate echocardiographic differences between pregnant women with gestational hypertension/preeclampsia and normotensive controls, providing a detailed characterization of cardiac structural and functional parameters to inform obstetric practice.

Methodology

This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Government Kilpauk Medical College, Chennai, following institutional ethics approval (IEC.NO-317/2020) with written informed consent. The investigation included 80 pregnant women aged 18-34 years in the third trimester, equally allocated into hypertensive (n=40) and normotensive control (n=40) groups through systematic age and parity matching. Inclusion criteria encompassed pregnant patients with systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg developing after 20 weeks of gestation. Comprehensive echocardiographic assessment was performed using standardized protocols, evaluating left ventricular morphology, systolic function, diastolic performance, left atrial volumetric measurements, and pulmonary hemodynamics.

Results

Demographic characteristics demonstrated successful matching between groups (age: 25.55 vs 25.88 years, p=0.753; parity distribution: p=0.263). Proteinuria assessment showed 85% of hypertensive patients versus 5% of controls with a protein-to-creatinine ratio ≥0.3 (p<0.001). Left ventricular structural analysis revealed significant chamber dilatation in hypertensive patients (left ventricular end-diastolic diameter (LVEDD): 50.75 vs 41.60 mm, p<0.001; left ventricular end-systolic diameter (LVESD): 34.48 vs 26.83 mm, p<0.001) with adaptive wall thickening (left ventricular posterior wall systolic (LVPWs): 1.16 vs 0.95 mm, p<0.001). Diastolic function assessment demonstrated impaired relaxation patterns, including a reduced E/A ratio (1.31 vs 1.51, p=0.010), elevated E/e′ ratio (9.05 vs 7.63, p<0.001), and prolonged mitral valve deceleration time (144.50 vs 123.35 ms, p<0.001). Left atrial volumetric analysis revealed substantial enlargement (left atrial volume index (LAVI): 31.52 vs 17.56 mL/m², p<0.001). Pulmonary artery systolic pressure was significantly elevated (18.70 vs 16.93 mmHg, p<0.001), while systolic function remained preserved (ejection fraction: 67.23% vs 65.15%, p=0.311).

Conclusion

This echocardiographic investigation demonstrates significant cardiac structural and functional alterations in gestational hypertension and preeclampsia, characterized by ventricular remodeling, diastolic dysfunction, and pronounced left atrial enlargement. These findings highlight cardiac adaptations in hypertensive pregnancy disorders that warrant further multicenter investigation to determine clinical applications for screening and risk assessment.