Abstract 12378: Association of Hypertensive Disorders of Pregnancy With Coronary Microvascular Dysfunction 8-10 Years After Delivery

Abstract

Introduction: Hypertensive disorders of pregnancy ( HDP ) are associated with subsequent adverse cardiac remodeling and cardiovascular disease ( CVD ). The pathophysiologic mechanisms linking HDP to CVD, including the role of myocardial microvascular disease, are understudied. Hypothesis: Individuals with HDP history will have abnormal microvascular coronary flow reserve ( CFR ) 8-10 years after delivery and abnormal CFR will correlate with left ventricular ( LV ) remodeling. Methods: Individuals with pregnancies delivered 2008-2010 underwent burst-replenishment myocardial contrast echocardiography (2017-2020) to quantify myocardial perfusion at rest and during dobutamine stress. Video intensity vs. time data were used to derive β, the rate of rise of video intensity, a correlate for myocardial blood flow. CFR was calculated as the ratio of β at peak stress to β at rest, averaged across LV myocardial regions of interest. Results: We studied 91 individuals (age 38±6, 9.1±0.9 years post-delivery), 19 with a history of HDP). Individuals with abnormal CFR (β ratio <2.0, n=13) had higher pre-pregnancy BMI, baseline heart rate, hemoglobin A1c, and a history of HDP (46.2% vs 16.7%; p =0.026). Association of CFR and HDP was attenuated after adjusting for pre-pregnancy BMI and hemoglobin A1c ( p =0.114). In exploratory subgroup analyses, individuals with both LV remodeling (relative wall thickness>0.42) and HDP had the highest proportion of microvascular dysfunction (41.7% vs. +HDP-LV remodeling 14.3%, -HDP+LV remodeling 7.7%; p =0.0498). Conclusions: Individuals with HDP history may be more likely to have coronary microvascular dysfunction one decade after delivery. Larger studies are needed to determine if microvascular dysfunction may be a mechanism for development of CVD among individuals with HDP.