Background: Gestational hypertension exerts a great challenge on the maternal cardiovascular system, in spite of this fact, there is lack of reports regarding the maternal diastolic function in gestational hypertension which precedes systolic dysfunction in any cardiovascular complications. Objectives: To evaluate the maternal left ventricular diastolic function in gestational hypertensive women in the third trimester by measuring the mitral inflow parameters with pulse wave Doppler and Tissue Doppler Imaging. Patients and Methods: This studywas conducted in Baghdad teaching hospital from November 2015 to June 2016. Sixty gestational hypertensive womenwith singleton pregnancy in the third trimester, aged 29.7 ± 5.9 year, gestational hypertension was defined as systolicblood pressure that is equal or more than 140 mmHg or diastolic bloodpressurethatequals or exceeds 90 mmHg and starts after 20 weeks of gestation without proteinuria were enrolled in this study. Another 50 Normal pregnant womenaged 28 ± 3.18year served as controls. The left ventricular diastolic function was studied using two transthoracic echocardiographic methods: Pulsed wave Doppler (PWD) to measure the transmitral flow velocity including the early maximum velocity of mitral inflow(E wave), the late maximum velocity of mitral inflow (A wave), and E/A ratio was recorded. Tissue Doppler imaging (TDI) to measure thelateralmitral annular velocity (lateral é), the septal mitral annular velocity (septal é) and their average (é) was calculated. The ratio of E/é was recorded. Results: Gestational hypertensive women hadsignificant lower E wave velocity compared tonormal pregnant women (P value was 0.001). "A"wave velocity was higher in gestational hypertensive women with statistical difference(P value 0.002) and E/A was significant low in gestational hypertension with P value <0.05. Tissue Doppler imaging showed significant difference in é velocity which was lowerin gestational hypertensive women (P value 0.001). E/éin gestational hypertension showed significantly higher value than controls with P value<0.05. Conclusion: Gestational hypertension puts the maternal heart under pressure and volume overload associated with impaired relaxation as manifested by the changes inthe left ventricular diastolic function measured by transthoracic echocardiography.
Background: Gestational hypertension represents a transient period of elevated blood pressure with special effects on the maternal left ventricle that is different from the effects observed in chronic essential hypertension; it affects a previously normal heart and lasts for a maximum of nine months associated with volume and pressure overload on the maternal heart. Tei index (also called myocardial performance index) was found to be a dependent combined index evaluating the systolic and diastolic function of the left ventricle and represents a sensitive indicator for many types of heart diseases.Objective: to evaluate the effects of gestational hypertension on the maternal myocardial function during the third trimester by measuring the Tie index using transthoracic echocardiography.Method: This study was performed in Baghdad teaching hospital in the time period from November 2015 to August 2016. The study included a total of 150 women; 100 women had gestational hypertension, in the third trimester of a singleton pregnancy and with a mean age (29.83 ± 5.33 year), gestational hypertension was identified as elevated systolic or diastolic blood pressure over 140/90 mmHg that emerges after the20th week of gestation with proteinuria level lower than 300 mg/dl. Another 50 normotensive pregnant women with singleton pregnancy and mean age (28 ± 3.18 year) were used as controls. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured to find the type of hypertrophy in gestational hypertension. Ejection fraction (EF) was measured with 2D directed M mode echocardiography,and isovolumic relaxation time (IVRT), isovolumic contraction rime (ICT) and ejection time (ET) were measured for both groups using pulse wave Doppler echocardiography in order to calculate the myocardial performance index which is also called “Tei index” and equals the sum of IVRT and IVCT divided by theET (Tei index = IVRT+IVCT/ET).Results: Left ventricular mass index and relative wall thickness were significantly higher in gestational hypertensive women, 41% of gestational hypertensive women had normal geometry and 59% had abnormal geometry (34% eccentric hypertrophy, 19% concentric hypertrophy and 6% concentric remodeling). IVRT and IVCT were significantly higher in gestational hypertensive women with p value of 0.0001 and P =0.003. ET showed a non-significant lower values (p= 0.34) in gestational hypertensive women. Tei index was significantly higher in Gestational hypertension (P=0.011).Conclusion: Women with gestational hypertension had altered myocardial function characterized by the higher Tei index values associated with eccentric hypertrophy which can be explained by the fact that gestational hypertension poses higher afterload on the left ventricle instead the state of low peripheral resistance that is ysually expected during normotensive pregnancy.
Background: Gestational hypertension represents a transient period of elevated blood pressure with special effects on the maternal left ventricle that is different from the effects observed in chronic essential hypertension; it affects a previously normal heart and lasts for a maximum of nine months associated with volume and pressure overload on the maternal heart. Tei index (also called myocardial performance index) was found to be a dependent combined index evaluating the systolic and diastolic function of the left ventricle and represents a sensitive indicator for many types of heart diseases. Objective: to evaluate the effects of gestational hypertension on the maternal myocardial function during the third trimester by measuring the Tie index using transthoracic echocardiography. Method: This study was performed in Baghdad teaching hospital in the time period from November 2015 to August 2016. The study included a total of 150 women; 100 women had gestational hypertension, in the third trimester of a singleton pregnancy and with a mean age (29.83 ± 5.33 year), gestational hypertension was identified as elevated systolic or diastolic blood pressure over 140/90 mmHg that emerges after the 20th week of gestation with proteinuria level lower than 300 mg/dl. Another 50 normotensive pregnant women with singleton pregnancy and mean age (28 ± 3.18 year) were used as controls. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured to find the type of hypertrophy in gestational hypertension. Ejection fraction (EF) was measured with 2D directed M mode echocardiography, and isovolumic relaxation time (IVRT), isovolumic contraction rime (ICT) and ejection time (ET) were measured for both groups using pulse wave Doppler echocardiography in order to calculate the myocardial performance index which is also called "Tei index" and equals the sum of IVRT and IVCT divided by the ET (Tei index = IVRT+IVCT/ET). Results: Left ventricular mass index and relative wall thickness were significantly higher in gestational hypertensive women, 41% of gestational hypertensive women had normal geometry and 59% had abnormal geometry (34% eccentric hypertrophy, 19% concentric hypertrophy and 6% concentric remodeling). IVRT and IVCT were significantly higher in gestational hypertensive women with p value of 0.0001 and P = 0.003. ET showed a non-significant lower values (p= 0.34) in gestational hypertensive women. Tei index was significantly higher in Gestational hypertension (P=0.011). Conclusion: Women with gestational hypertension had altered myocardial function characterized by the higher Tei index values associated with eccentric hypertrophy which can be explained by the fact that gestational hypertension poses higher afterload on the left ventricle instead the state of low peripheral resistance that is ysually expected during normotensive pregnancy.
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