Onset of hypertension during pregnancy is associated with long-term worse blood pressure control and adverse cardiac remodeling

Mesquita, Roberto Frediani Duarte; Reis, M.F.; Beppler, Ana Paula; Bellinazzi, Vera Regina; Mattos, Sandra S.; Lima-Filho, José Luiz de; Cipolli, José A.; Coelho‐Filho, Otávio R.; Pio-Magalhães, José A.; Sposito, Andrei C.; Matos‐Souza, José R.; Nadruz, Wilson

doi:10.1016/j.jash.2014.09.006

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…[292][293][294] Similarly, hypertensive pregnant women may experience a five-fold increase in relative wall thickness, without proportional enlargement of LVEDD, leading to concentric remodelling, 276,295,296 which can be exacerbated by environmental, genetic, inflammatory, and placental factors. 296 Despite preserved systolic function, diastolic dysfunction is commonly observed in gestational hypertension, usually manifesting after 20 weeks of gestation and resolving within 42 days after delivery. 291,295,297 During RR, diastolic dysfunction usually resolves within 2 months postpartum.…”

Section: Postpartum-induced Reverse Remodellingmentioning

confidence: 99%

“…284,[287][288][289][290][291] In the third trimester, obese pregnant women often display reduced myocardial performance, increased LVM (concentric remodelling), and lower EF, predisposing them to diastolic and systolic dysfunction. [292][293][294] Similarly, hypertensive pregnant women may experience a five-fold increase in relative wall thickness, without proportional enlargement of LVEDD, leading to concentric remodelling, 276,295,296 which can be exacerbated by environmental, genetic, inflammatory, and placental factors. 296 Despite preserved systolic function, diastolic dysfunction is commonly observed in gestational hypertension, usually manifesting after 20 weeks of gestation and resolving within 42 days after delivery.…”

Section: Postpartum-induced Reverse Remodellingmentioning

confidence: 99%

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Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

Falcão‐Pires,

Ferreira,

Trindade

et al. 2024

European J of Heart Fail

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Cardiovascular disease (CVD) is the leading cause of morbimortality in Europe and worldwide. CVD imposes a heterogeneous spectrum of cardiac remodelling, depending on the insult nature, that is, pressure or volume overload, ischaemia, arrhythmias, infection, pathogenic gene variant, or cardiotoxicity. Moreover, the progression of CVD‐induced remodelling is influenced by sex, age, genetic background and comorbidities, impacting patients' outcomes and prognosis. Cardiac reverse remodelling (RR) is defined as any normative improvement in cardiac geometry and function, driven by therapeutic interventions and rarely occurring spontaneously. While RR is the outcome desired for most CVD treatments, they often only slow/halt its progression or modify risk factors, calling for novel and more timely RR approaches. Interventions triggering RR depend on the myocardial insult and include drugs (renin–angiotensin–aldosterone system inhibitors, beta‐blockers, diuretics and sodium–glucose cotransporter 2 inhibitors), devices (cardiac resynchronization therapy, ventricular assist devices), surgeries (valve replacement, coronary artery bypass graft), or physiological responses (deconditioning, postpartum). Subsequently, cardiac RR is inferred from the degree of normalization of left ventricular mass, ejection fraction and end‐diastolic/end‐systolic volumes, whose extent often correlates with patients' prognosis. However, strategies aimed at achieving sustained cardiac improvement, predictive models assessing the extent of RR, or even clinical endpoints that allow for distinguishing complete from incomplete RR or adverse remodelling objectively, remain limited and controversial. This scientific statement aims to define RR, clarify its underlying (patho)physiologic mechanisms and address (non)pharmacological options and promising strategies to promote RR, focusing on the left heart. We highlight the predictors of the extent of RR and review the prognostic significance/impact of incomplete RR/adverse remodelling. Lastly, we present an overview of RR animal models and potential future strategies under pre‐clinical evaluation.

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Section: Postpartum-induced Reverse Remodellingmentioning

confidence: 99%

Section: Postpartum-induced Reverse Remodellingmentioning

confidence: 99%

Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

Falcão‐Pires,

Ferreira,

Trindade

et al. 2024

European J of Heart Fail

View full text Add to dashboard Cite

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Cardiovascular risk factors during pregnancy impact the postpartum cardiac and vascular reverse remodeling

Ferreira,

Azevedo,

Morais

et al. 2023

American Journal of Physiology-Heart and Circulatory Physiology

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Pregnant women with cardiovascular risk(CVR) factors are highly prone to develop cardiovascular disease later in life. Thus, recent guidelines suggest extending the follow-up period to 1-year after delivery. We aimed to evaluate cardiovascular remodeling during pregnancy and determine which CVR factors and potential biomarkers predict postpartum cardiac and vascular reverse remodeling(RR). Our study included a prospective cohort of 76 healthy and 54 obese and/or hypertensive and/or with gestational diabetes pregnant women who underwent transthoracic echocardiography, pulse-wave velocity (PWV), and blood collection at the 1st (1T) and 3rd trimesters (3T) of pregnancy as well as at the 1st/6th/12th month after delivery. Generalized linear mixed-effects models evaluate the extent of RR and its potential predictors. Pregnant women develop cardiac hypertrophy, as confirmed by a significant increase in left ventricular mass(LVM). Moreover, the ventricular filling pressure(E/e') and atrial volume increased significantly during gestation. Significant regression of left ventricularvolume, LVM, and filling pressures was observed as soon as 1 month postpartum. The LV global longitudinal strain worsened slightly and recovered at 6 months postpartum. PWV decreased significantly from 1T to 3T and normalized 1 month postpartum. We found that arterial hypertension, smoking habits, and obesity were independent predictors of high LVM during pregnancy and postpartum. High C-reactive protein and low ST2/IL33-receptor levels are potential circulatory biomarkers of worse LVM regression. Arterial hypertension, age, and gestational diabetes positively correlated with PWV. Altogether, our findings highlighted arterial hypertension as a critical risk factor for worse RR, CRP and ST2/IL33-receptor as potential biomarkers of postpartum hypertrophy reversal.

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Stretch-induced compliance mechanism in pregnancy-induced cardiac hypertrophy and the impact of cardiovascular risk factors

Ferreira,

Azevedo,

Morais

et al. 2024

American Journal of Physiology-Heart and Circulatory Physiology

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Introduction: Pressure-overload-induced hypertrophy compromises cardiac stretch-induced compliance (SIC) after acute volume overload (AVO). We hypothesized that SIC could be enhanced by physiological hypertrophy induced by pregnancy's chronic volume overload. This study evaluated SIC-cardiac adaptation in pregnant women with or without cardiovascular risk (CVR) factors. Methods: Thirty-seven (1st trimester, 1stT) and a separate thirty-one (3rd trimester, 3rdT) women (healthy or with CVR factors [obesity and/or hypertension and/or with gestational diabetes]) underwent echocardiography determination of left ventricular (LV) end-diastolic volume (LVEDV) and E/e' before (T0), immediately after (T1) and 15min after (T2; SIC) AVO induced by passive leg elevation. Blood samples for NT-proBNP quantification were collected before and after the AVO. Results: Acute leg-elevation significantly increased inferior vena cava diameter and stroke volume from T0 to T1 in both 1stT and 3rdT, confirming AVO. LVEDV and E/e' also increased immediately after AVO (T1) in both 1stT and 3rdT. SIC adaptation (T2-15min after AVO) significantly decreased E/e' in both trimesters, with additional expansion of LVEDV only in the 1stT. NT-proBNP increased slightly after AVO but only in the 1stT. CVR factors, but not parity or age, significantly impacted SIC cardiac adaptation. Conclusion: A distinct functional response to SIC was observed between 1stT and 3rdT, which was influenced by CVR factors. The LV of 3rdT pregnant women was hypertrophied, showing a structural limitation to dilate with AVO, while the lower LV filling pressure values suggest increased diastolic compliance.

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Onset of hypertension during pregnancy is associated with long-term worse blood pressure control and adverse cardiac remodeling

Cited by 3 publications

References 19 publications

Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

Cardiovascular risk factors during pregnancy impact the postpartum cardiac and vascular reverse remodeling

Stretch-induced compliance mechanism in pregnancy-induced cardiac hypertrophy and the impact of cardiovascular risk factors

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