#3050 Hemodynamic study of hypertensive disorders in pregnancy using cardiothoracic bioimpedance

Abstract

Abstract Background and Aims Hypertensive disorders in pregnancy (HDP) are a major cause of maternal and perinatal morbidity and mortality. There is still a need for the development of biomarkers for early diagnosis of the severity of the condition. Thoracic electrical bioimpedance (TEB) is a non-invasive hemodynamic technique based on the resistance to the flow of electrical current. We investigated hemodynamic changes in pregnant/postpartum women with HDP using TEB. Method A retrospective observational study was conducted in pregnant and postpartum women with hypertension monitored by TEB. Indirect changes were analyzed in: cardiac work, left cardiac work index (LCWI kg⋅m/m2) and calculated cardiac output (CO ml/min=systolic volume -SV ml- × heart rate -HR bpm-); fluid status, thoracic fluid content index (TFCI l/kOhm/m2); and resistances, systemic vascular resistance index (SVRI dyn.s.cm-5.m2). Normality of variables was assessed by Shapiro-Wilk test and correlation analysis was performed by Pearson/Spearman tests. Statistical inference between the hypertension-preeclampsia and pregnancy-postpartum groups was performed using Student's/Mann-Whitney U tests. Analysis was performed using STATA 12. Results Fifty-five patients were included with a mean age of 36.5 years (SD 4.54), 69% were older than 35 years. Pregnant women accounted for 86% of the TEB evaluations, the majority (93.6%) in the third trimester. There was chronic hypertension in 7.27% and pre-eclampsia in 18.18% of previous pregnancies. The diagnoses were: pre-eclampsia (56.36%), gestational hypertension (40%) and HELLP syndrome (3.64%). The mean blood pressure was 144/89 (SD 16/11) mmHg. Mean proteinuria was 363.2 (range: 10.3-23220) mg/g. The median values were as follow: LCWI: 5.05 (IQR: 1.4) kg⋅m/m2; CO: 6352 (IQR: 2345) ml/min; TFCI: 17.9 (IQR: 6.3) l/kOhm/m2; SVRI: 2167.63 (SD: 462.87) dyn.s.cm-5.m2. LCWI showed a weak positive correlation with systolic blood pressure (SBP) and a strong correlation with diastolic blood pressure (DBP) (Rho 0.2899 and 0.5176, respectively). There was also a positive and moderate correlation between SVRI and SBP and DBP (r 0.4265 and 0.4019, respectively). There was no correlation between CO or TFCI and SBP or DBP. No statistically significant differences in hemodynamic parameters were found between gestational hypertension and pre-eclampsia, nor between pregnant and postpartum women. Conclusion Increased blood pressure in the setting of HDP correlates with increased LCWI and systemic resistance independent of fluid retention. An increase in systemic vascular resistance measured by TEB (which decreases in normal pregnancy) may be an early diagnostic marker of HDP. These findings require further validation in a larger cohort, including a control group of pregnant women without hypertension.