cardiac structure and function
six months after normal and hypertensive pregnancies – the P4 study
Mikhail Sarofim , George Mangos, George Youssef, Lily Xu, Lynne Roberts, Amanda Henry, Gregory Davis, Caroline Homer,
Franziska Pettit, Mark Brown
disorders of pregnancy (HDP) are associated with increased post-partum
cardiovascular risk compared to normal pregnancy (NP); however the association
between cardiac structural/functional changes following an HDP and
cardiovascular risk is not clear. Echocardiography is a non-invasive tool
useful in detecting early systolic/diastolic dysfunction.
assess cardiac structure/function by 2D-echocardiogram in women, six-months
after NP or pregnancy complicated by gestational hypertension or pre-eclampsia
prospective cohort was recruited to the ongoing P4 (Postpartum Physiology,
Psychology, and Paediatric follow-up) study at St George Hospital, Sydney. Two-dimensional-echocardiography was
performed six-months after either NP or HDP. Cardiac sonographers were blinded
to a NP or an HDP. All studies were performed on the Phillips-iE33 and Epic
machines at St George Hospital. Women with chronic hypertension were excluded.
Statistical analysis was completed using independent t-tests.
women have been recruited to date (n=22 NP, n=26 HDP). The HDP group showed subtle evidence of
structural change with trend to increased 2D ventricular septal thickness
(8.9±1.3 v 8.3±0.9mm, HDP v NP, p=0.08), increased posterior wall thickness
(8.8±1.1 v 7.8±0.7mm, HDP v NP, p<0.01) and increased relative wall
thickness (0.39±0.06 v 0.35±0.04, HDP v NP, p<0.01 (nr<0.42)). Functionally, the HDP group had slower ventricular
diastolic filling (E/A ratio 1.4±0.4 v 1.7±0.4, HDP v NP, p<0.05), trending
towards diastolic dysfunction (E/A NR>1.0). Systolic function was similar between groups, measured by ejection
fraction (63±4 v 62±15, HDP v NP, p=n.s.) and global longitudinal strain
(-19.3±1.6 v -19.8±5.3, HDP v NP, p=n.s.).
Conclusion: Six-months post-partum, women with HDP had early
structural and functional changes compared to NP. There was no
systolic dysfunction or strain but rather subtle features of increased
ventricular mass and diastolic dysfunction. The cardiac changes, although
within (current) normal ranges, may be useful in future if included in CV risk