Correlation between multi-parameter echocardiographic indicators and adverse pregnancy outcomes in women of advanced maternal age with pregnancy-induced hypertension syndrome: clinical application value

TL;DR

This study shows that echocardiographic indicators can predict adverse pregnancy outcomes in older women with pregnancy-induced hypertension.

Contribution

The study introduces a combined echocardiographic model with high accuracy for predicting adverse outcomes in advanced maternal age patients with PIHS.

Findings

Adverse outcome group showed significantly altered echocardiographic parameters compared to the favorable group.

A combined model of multiple echocardiographic variables achieved an AUC of 0.925, indicating strong predictive power.

Clinical risk factors like hypertension history and family history were independently associated with poor outcomes.

Abstract

Hypertensive disorders of pregnancy are a major cause of maternal and perinatal morbidity and mortality, particularly among women of advanced maternal age.

This retrospective study evaluated the correlation between echocardiographic parameters and adverse pregnancy outcomes in 240 women aged ≥35 years diagnosed with pregnancy-induced hypertension syndrome (PIHS) from February 2019 to June 2022. Patients were classified into a favorable outcome group (n = 183) and an adverse outcome group (n = 57). Echocardiographic indicators—including ejection fraction (EF), stroke volume (SV), cardiac output (CO), E/A ratio, early diastolic mitral annular velocity (E′), E/E′ ratio, left atrial volume index (LAVI), pulmonary venous flow velocities (S-, D-, Ar-waves), and myocardial performance (Tei) index—were compared between groups.

Women with adverse outcomes had significantly lower EF, SV, CO, E/A ratio, and E′, while showing higher E/E′, LAVI, Ar-wave velocity, and Tei index, with reduced S- and D-wave velocities (all p < 0.001). A history of hypertension, nephritis, and a family history of hypertension were also identified as significant clinical risk factors. Multivariable logistic regression confirmed that both clinical and echocardiographic parameters were independently associated with poor outcomes. Receiver operating characteristic analysis demonstrated high discriminative power for key indices (AUC range: 0.78–0.90), and a combined model integrating multiple echocardiographic variables achieved an AUC of 0.925, indicating excellent predictive performance.

These findings suggest that multi-parameter echocardiographic assessment provides a reliable, non-invasive approach for identification of high-risk PIHS patients, supporting more effective monitoring and timely intervention to improve maternal and fetal prognosis.

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