Abstract 10682: Peripartum Myocardial Strain Analysis: A Marker for Adverse Cardiovascular Outcomes?

Abstract

Introduction: Hypertensive disorders of pregnancy (HDP) contribute significantly to adverse cardiovascular (CV) outcomes in peripartum women, and echocardiography helps stratify risk and guide management. Global longitudinal strain (GLS), a marker of left ventricular (LV) systolic function, has not been well-characterized in peripartum women with or without HDP. Hypothesis: We hypothesized that GLS is abnormal in women with prior HDP and may predict adverse CV outcomes. Methods: We retrospectively analyzed 141 women with echocardiograms performed during the peripartum period (6 weeks antepartum to 8 weeks postpartum). We investigated relationships between adverse CV outcomes and clinical and echocardiographic variables, including peak systolic GLS. Prior HDP was defined as a preceding diagnosis of gestational hypertension (HTN), chronic HTN or preeclampsia. Results: Women with prior HDP (72/141, 51%) were older (35 vs 32 years), more often obese (61% vs 34%) and had higher mean arterial pressure (96 vs 82 mmHg) compared to those without prior HDP (p<0.01 for all). Women with prior HDP had greater LV thickness (1.0 vs 0.9 cm) and more frequently abnormal inferior vena cava (IVC) size and collapsibility (p<0.01 for all), although median LV ejection fraction (64% vs 65%) and GLS (-19.6 vs -20.2) were similar. During follow-up of 2.5 years, women with prior HDP had more CV-related emergency department (ED) visits (36% vs 16%, p<0.01) and hospitalizations (32% vs 12%, p<0.01). Using multivariable modeling, left atrial area (LAA) and IVC size better predicted CV-related ED visits and hospitalizations when compared to age, obesity and history of gestational HTN ( Figure ). Conclusions: Although GLS did not predict CV outcomes, abnormal LAA and IVC suggest elevated left and right atrial pressure is related to HDP and CV outcomes. Further study of LV diastolic or right ventricular dysfunction may elucidate mechanisms contributing to adverse outcomes in this population.