Left Ventricular Concentric Geometry as a Risk Factor in Gestational Hypertension

Novelli, G. P.; Valensise, H.; Vasapollo, B.; Larciprete, G.; Altomare, F.; Pierro, G. Di; Casalino, B.; Galante, Alberto; Arduini, Domenico

doi:10.1161/01.hyp.0000058001.67791.0a

Cited by 44 publications

(63 citation statements)

References 30 publications

(29 reference statements)

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“…Moreover, the finding of an elevated postpartum TVR and BP values in all of the women with an abnormal outcome compared with the uneventful group might indicate a possible pregestational predisposition to pregnancy complications, as hypothesized previously. 22,23 This hypothesis is strengthened in this study by the fact that differences in left ventricular morphological parameters and TVR were still present 6 to 8 months postpartum. Our study shows that, before complications appear, the maternal vascular function and cardiac morphology of pregnant patients destined to have complications differ dramatically from those destined to have a normal outcome of pregnancy and that this cardiovascular dissimilarities might be used to reliably classify them, in particular through TVR.…”

Section: Discussionsupporting

confidence: 54%

“…In recent years, maternal cardiac function was studied in normal and complicated pregnancy obtaining important information on systolic and diastolic function and on morphological parameters of the left ventricle. [13][14][15][16][17][18][19][20][21][22][23] In particular total vascular resistance (TVR) was found to be an important parameter in the early identification of hypertensive patients who subsequently developed complications. 22 In our previous pilot study, 24 we observed that normotensive high-risk patients with bilateral notch of the uterine arteries who subsequently showed abnormal outcome of pregnancy had higher TVR compared with the normal-outcome group.…”

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confidence: 99%

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Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

Vasapollo¹,

Novelli²,

Valensise³

2008

Hypertension

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Abstract-We evaluated the predictive value of elevated total vascular resistance on the outcome of pregnancy in normotensive high-risk primigravidas with bilateral notching of the uterine artery Doppler. A total of 526 high-risk primigravidas referred to the obstetrics outpatient clinic of Tor Vergata University with bilateral notching of the uterine artery at 20 to 22 weeks' gestation were submitted to a maternal echocardiographic examination and uterine artery Doppler evaluation at 24 weeks' gestation. Blood pressure was recorded at the time of the examination, total vascular resistance was calculated, and the geometric pattern of the left ventricle was assessed. Patients were followed until the end of pregnancy to detect fetal/maternal adverse outcomes (gestational hypertension, preeclampsia, abruptio placentae, fetal growth restriction, perinatal death, etc). A total of 111 of the 526 pregnancies showed a bilateral notch at 24 weeks' gestation, and 97 had an adverse outcome (18.44%). The best independent predictor for maternal and fetal complications was total vascular resistance (odds ratio: 91.25; 95% CI: 39.64 to 210.05; PϽ0.001). The cutoff value was 1400 dynes ⅐ s ⅐ cm Ϫ5, with a sensitivity and a specificity of 89% and 94%, respectively. A high relative wall thickness of the left ventricle (Ͼ0.37; odds ratio: 2.47; 95% CI: 1.12 to 5.44) and a hypertrophized ventricle (left ventricular mass Ͼ130 g; odds ratio: 2.52; 95% CI: 1.12 to 5.64) were also independent predictors (PϽ0.05). Echocardiography might identify at 24 weeks' gestation patients who subsequently develop maternal and fetal complications through the assessment of maternal hemodynamics and left ventricular geometry. (Hypertension. 2008;51:1020-1026.)

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Section: Discussionsupporting

confidence: 54%

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confidence: 99%

Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

Vasapollo¹,

Novelli²,

Valensise³

2008

Hypertension

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“…21,22 Although some echocardiographic studies showed that women developing hypertensive complications during pregnancy may have different LA dimensions than controls, [23][24][25][26] the potential link between LA abnormality detected early in pregnancy by echocardiography or ECG and development of hypertensive disorders remains elusive. However, some possible mechanisms are supported by epidemiological data and experimental models.…”

Section: Discussionmentioning

confidence: 99%

Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy

Angeli

Verdecchia²,

Narducci

et al. 2011

Hypertens Res

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Prediction of hypertensive complications during pregnancy remains limited, especially in healthy and initially normotensive women. We conducted a prospective screening study for hypertensive complications in pregnant women. We studied 221 nulliparous healthy and normotensive women with singleton pregnancies whose first routine visit was carried out before the twelfth week of gestation. We tested several demographic, clinical and laboratory variables as predictors of a composite pool of prespecified events, including gestational hypertension, preeclampsia or eclampsia. We analyzed the potential additive role of ECG in the identification of women at increased risk of hypertensive disorders. Mean age at entry was 30 years. During pregnancy, there were 28 prespecified events (22 women with gestational hypertension, 5 with preeclampsia and 1 with eclampsia). In univariate analyses, blood pressure (BP), weight, body mass index (BMI) and left atrial (LA) abnormality detected by ECG in lead V 1 showed an association with the risk of hypertensive disorders (all Po0.05). In a multivariable analysis, only mean BP (OR: 3.08, 95% confidence interval (CI): 1.61-5.92; P¼0.001 for each 10 mm Hg increase) and LA abnormality in lead V 1 (OR: 4.35, 95% CI: 1.84-10.31; P¼0.001) were independent predictors of hypertensive disorders. The final model discriminated well between women who developed hypertensive disorders and women who remained normotensive (AUC¼0.75; 95% CI: 0.67-0.84; Po0.0001). This study suggests that standard ECG is valuable to refine risk stratification for hypertensive disorders in initially normotensive pregnant women. LA abnormality, easily detected by simple visual inspection of the traditional ECG, and mean arterial pressure (MAP), allows a rapid and effective risk stratification for hypertensive disorders.

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“…In cases of fetal growth restriction, end-diastolic volume, stroke volume, cardiac output, left ventricular mass, and left atrial function were demonstrated to be reduced compared with normal patients, while IVRT was prolonged 13 . Some of these changes may even precede the onset of the full clinical syndrome: Novelli and colleagues found left ventricular concentric geometry to be significantly associated with adverse outcome in women with gestational hypertension 15 , and the same group showed that in women with fetal growth restriction compared to normal fetuses, indices of systolic and diastolic ventricular function are depressed 16 . It is now established that in women who develop preeclampsia, the subsequent lifetime risk of death from cardiovascular disease is eight-fold higher than in those with a normal pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Maternal cardiac function in early pregnancies with high uterine artery resistance

Prefumo

Sharma

Brecker

et al. 2006

Ultrasound in Obstet & Gyne

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Objective To compare the maternal cardiac function and serum concentration of cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in first-trimester patients, according to uterine artery Doppler velocimetry (UADV). Methods This cross-sectional study included singleton pregnancies with normal UADV (n = 17) and abnormal UADV (n = 19). Maternal echocardiography was performed and blood samples were taken at 11-14 weeks. Echocardiographic parameters included: (a) left ventricular (LV) long axis velocities; (b) atrial size; (c) LV filling pressure; (d) the ratio of peak mitral flow velocity in early diastole and early mitral annular diastolic velocity (E/Ea ratio); and (e) the E/flow propagation velocity ratio. The maternal serum concentrations of cTnT and NT-proBNP were determined by sensitive and specific immunoassays.Results Patients with abnormal UADV had higher estimated left ventricular filling pressure (P = 0.004), higher E/Ea ratio (P = 0.03), higher E/flow propagation ratio (P = 0.02), and lower LV long axis velocity (P = 0.02) than those with normal UADV. There were no significant differences in the maternal serum concentration of cTnT or NT-proBNP. Conclusions

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Left Ventricular Concentric Geometry as a Risk Factor in Gestational Hypertension

Cited by 44 publications

References 30 publications

Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy

Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy

Maternal cardiac function in early pregnancies with high uterine artery resistance

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