OP 22 Abnormal mid-trimester cardiac strain in African American patients with chronic hypertension predates superimposed preeclampsia – Preeclampsia a possible cardiovascular disease

Abstract

Background African-American (AA) women are at higher risk of cardiac dysfunction during pregnancy which is exacerbated by chronic hypertension (cHTN). The aim of this study is to describe the prevalence of cardiac dysfunction, as measured by cardiac strain, using highly sensitive speckle-tracking echocardiography in asymptomatic AA women with cHTN. We further wanted to explore the association between cardiac dysfunction in mid-trimester and perinatal outcomes. Methods This is a retrospective cohort study of patients seen in a high-risk obstetrics clinic at the University of Chicago between January 2014 and December 2016. Asymptomatic patients with a singleton pregnancy, history of cHTN and who had an echocardiogram done were eligible. Clinical and demographic information was collected from medical records. Cardiac strain was calculated from stored images and global peak longitudinal strain (GLS) was measured using automated software. Results A total of 60 patients were included in this analysis, among which 48 (80.0%) were AA. The mean BMI was 41.1, median age was 34 years, and the gestational age (GA) at the time of the echo was 20.4 weeks with GA at delivery of 37.9 weeks. Patients were divided into normal and abnormal GLS based on their cardiac strain (GLS ⩽−19), with 56.7% (34 patients) expressing abnormal strain. Patients with abnormal strain were similar in age, BMI, and expressed similar blood pressures at the time of ECHO and at the last prenatal visit [AM1]. Compared to women with normal strain, those with abnormal strain had lower stroke volume (69.0 vs 81.5; p = 0.001) and ejection fraction (49.6 vs 57.5; p Conclusion The prevalence of asymptomatic cardiac dysfunction is high in this predominantly young AA pregnant population with cHTN and is associated with higher rates of superimposed preeclampsia and preterm delivery. Further studies need to validate these findings whether primary cardiac dysfunction can lead to development of preeclampsia and whether interventions to improve cardiac function can lead to improved perinatal outcomes.