Left ventricular geometry in pregnancy-induced hypertension

Abstract

The changes induced by transient hypertension upon cardiac geometry (G) are unclear. Pregnancy-induced hypertension (PIH) offers a natural and spontaneous model of this condition. To assess geometric changes according to two-dimensionally guided M-mode echocardiography, we compared patients with PIH with normal pregnant women (NPW). Fifty-five women, aged 28.5 ± 7.5 years, with PIH (defined as blood pressure >140/90 mm Hg in the third trimester of pregnancy and without a history of hypertension) were compared with 57 NPW aged 30.7 ± 7.5 years. Left ventricular mass index (LVMI) (Devereux formula) and relative wall thickness (RWT) (Ganau formula) were calculated by means of echocardiography done in the left lateral decubitus 2 to 4 days postpartum. Subjects were considered to have: normal geometry (NG) if both LVMI and RWT fell below the mean ± 1 SD or 2 SD; concentric hypertrophy (CH) if both were elevated; eccentric hypertrophy (EH) if LVMI was elevated and RWT was normal; and concentric remodeling (CR) if LVMI was normal and RWT was elevated. Comparisons were performed by the Student t test. Patients with PIH had higher LVMI (106 ± 29.4 v 90.6 ± 19.8 g/m 2; P < .05) and RWT (0.41 ± 0.07 v 0.38 ± 0.05; P < .05). Considering the mean ± 1 SD of NPW as the limit of normality the G pattern was NG in 26 (47%) and abnormal in 29 (53%), of which 14 (25.5%) had EH, 11 (20%) had CR, and four (7%) had CH. If we considered the mean ± 2 SD, the G pattern was NG in 46 (84%) and abnormal G in nine (16%), EH in four (7%), CR in three (5%), and CH in 2 (4%). According to these data, women with PIH had higher LVMI and RWT compared with NPW. The most frequent abnormal G patterns were EH and CR.