753: Noninvasive hemodynamic-impedance cardiography (ICG) assessment of hypertensive third trimester patients: Correlation with disease severity and final diagnosis

Abstract

To determine if noninvasive hemodynamic profiling with impedance cardiography (ICG) during initial evaluation of hypertensive third trimester patients reliably reflects a patient's final diagnosis of chronic hypertension (CHTN), gestational hypertension (GH), mild preeclampsia (MPRE), severe preeclampsia (SPRE) or superimposed preeclampsia (SuPRE). Prospective observational study of third trimester women evaluated for acute or chronic hypertension, ICG assessment was performed (CardioDynamics) prior to any intervention. A hemodynamic profile for each patient was recorded and compared to subsequent hospital course, laboratory findings, and final diagnostic category (ACOG criteria). Global comparisons were undertaken using ANOVA to investigate differences in means and chi-square for differences in proportions among patient groups. ICG hemodynamic parameters in 129 enrolled and consented women displayed considerable heterogeneity within and among the five categories of hypertensive disorders. Patients with SPRE and/or SuPRE demonstrated significantly depressed cardiac function (cardiac index) and significantly higher systolic blood pressure, mean arterial pressure, systemic vascular resistance, pulse pressure and thoracic fluid content than other groups (p<0.05). If the systemic vascular resistance index (SVRI) was >3000 and thoracic fluid content (TFC) was >40, 80% of patients had either SPRE or SuPRE (82% if either was present); SuPRE and SPRE were not present in 90% of cases when thresholds for both indices were not met. ICG in this setting provides the clinician with hemodynamic parameters that facilitate identification of the patient with SPRE or SuPRE. The heterogeneity of findings does not permit reliable patient assignment into the five categories of gestational hypertensive disease currently in practice use.