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Echocardiographic Assessment of Structural and Hemodynamic Changes in Hypertension-Related Pregnancy

  • Kim, Mi-Jeong (Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Seo, Jonggoo (Division of Cardiology, Department of Internal Medicine, Hallym Hospital) ;
  • Cho, Kyoung-Im (Division of Cardiology, Department of Internal Medicine, Kosin University School of Medicine) ;
  • Yoon, Se-Jung (Division of Cardiology, Department of Internal Medicine, NHIC Ilsan Hospital) ;
  • Choi, Jung-Hyun (Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Shin, Mi-Seung (Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center)
  • 투고 : 2015.07.03
  • 심사 : 2016.02.01
  • 발행 : 2016.03.27

초록

Background: Pregnancy induces dramatic cardiovascular changes in order to meet the increasing metabolic needs. Adaptive change of left ventricle (LV) might be modified in pregnancy complicated by hypertension. Methods: Data from 193 consecutive pregnant women were analyzed. Clinical and echocardiographic data were compared in normotensive and hypertensive women. Results: Significantly higher LV mass indexed by height was observed in hypertensive women compared with normotensive women ($84{\pm}21g/m$ vs. $97{\pm}20g/m$, p = 0.001). Diastolic function measured by the ratio of peak velocity of early diastolic transmitral blood flow to early diastolic mitral annular velocity was impaired in hypertensive women ($11.0{\pm}3.0$ vs. $9.2{\pm}2.5$, p < 0.001). Such change was more prominent in women with gestational hypertension (GH) than those with chronic hypertension (CH). Heavy maternal weight was an independent factor associated with LV hypertrophy (LVH) in both normotensive and hypertensive women. Overt eccentric LVH was more frequent than concentric remodeling/hypertrophy (24% vs. 8.4%) in GH, while the opposite result was observed in CH (14% vs. 23%). Conclusion: Hypertensive pregnancy is associated with significant LVH and diastolic dysfunction. CH seems to induce different LV remodeling pattern from GH. Heavy maternal weight during pregnancy might intensify the unfavorable remodeling of LV, particularly in hypertensive pregnancy.

키워드

과제정보

연구 과제 주관 기관 : Korean Society of Echocardiography

참고문헌

  1. Warnes CA. Pregnancy and heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, editors. Braunwald's heart disease: a textbook of cardiovascular medicine. 10th ed. Philadelphia: Elsevier Saunders;2014. p. 1755-70.
  2. European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM), Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JS, Gohlke-Baerwolf C, Gorenek B, Iung B, Kirby M, Maas AH, Morais J, Nihoyannopoulos P, Pieper PG, Presbitero P, Roos-Hesselink JW, Schaufelberger M, Seeland U, Torracca L; ESC Committee for Practice Guidelines. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011;32:3147-97. https://doi.org/10.1093/eurheartj/ehr218
  3. Geva T, Mauer MB, Striker L, Kirshon B, Pivarnik JM. Effects of physiologic load of pregnancy on left ventricular contractility and remodeling. Am Heart J 1997;133:53-9. https://doi.org/10.1016/S0002-8703(97)70247-3
  4. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-63. https://doi.org/10.1016/j.echo.2005.10.005
  5. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107-33. https://doi.org/10.1016/j.echo.2008.11.023
  6. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713; quiz 786-8. https://doi.org/10.1016/j.echo.2010.05.010
  7. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450-8. https://doi.org/10.1016/0002-9149(86)90771-X
  8. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, Vargiu P, Simongini I, Laragh JH. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992;19:1550-8. https://doi.org/10.1016/0735-1097(92)90617-V
  9. Katz R, Karliner JS, Resnik R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation 1978;58(3 Pt 1):434-41. https://doi.org/10.1161/01.CIR.58.3.434
  10. Gant NF, Daley GL, Chand S, Whalley PJ, MacDonald PC. A study of angiotensin II pressor response throughout primigravid pregnancy. J Clin Invest 1973;52:2682-9. https://doi.org/10.1172/JCI107462
  11. Gant NF, Worley RJ, Everett RB, MacDonald PC. Control of vascular responsiveness during human pregnancy. Kidney Int 1980;18:253-8. https://doi.org/10.1038/ki.1980.133
  12. Simmons LA, Gillin AG, Jeremy RW. Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy. Am J Physiol Heart Circ Physiol 2002;283:H1627-33. https://doi.org/10.1152/ajpheart.00966.2001
  13. Ghi T, degli Esposti D, Montaguti E, Rosticci M, Tancredi S, Youssef A, di Giovanni MV, Pilu G, Borghi C, Rizzo N. Maternal cardiac evaluation during uncomplicated twin pregnancy with emphasis on the diastolic function. Am J Obstet Gynecol 2015;213:376.e1-8. https://doi.org/10.1016/j.ajog.2015.05.003
  14. Easterling TR, Benedetti TJ, Schmucker BC, Millard SP. Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study. Obstet Gynecol 1990;76:1061-9.
  15. Chaiworapongsa T, Chaemsaithong P, Yeo L, Romero R. Pre-eclampsia part 1: current understanding of its pathophysiology. Nat Rev Nephrol 2014;10:466-80. https://doi.org/10.1038/nrneph.2014.102
  16. Cho KI, Kim SM, Shin MS, Kim EJ, Cho EJ, Seo HS, Shin SH, Yoon SJ, Choi JH. Impact of gestational hypertension on left ventricular function and geometric pattern. Circ J 2011;75:1170-6. https://doi.org/10.1253/circj.CJ-10-0763
  17. Zanati Bazan SG, Borges VM, Martin LC, Magalhaes CG, Hueb JC, de Arruda Silveira LV, Peracoli JC, Matsubara BB. Disproportionate pregnancy-induced myocardial hypertrophy in women with essential hypertension. Am J Hypertens 2013;26:816-21. https://doi.org/10.1093/ajh/hpt023
  18. Leddy MA, Power ML, Schulkin J. The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol 2008;1:170-8.

피인용 문헌

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  3. Role of miR‐106‐mediated mitogen‐activated protein kinase signaling pathway in oxidative stress injury and inflammatory infiltration in the liver of the mouse with gestational hypert vol.122, pp.9, 2021, https://doi.org/10.1002/jcb.29552