Maternal diastolic dysfunction and left ventricular geometry in gestational hypertension

The objective of this study was to evaluate diastolic parameters and left V entricular geometry in gestational hypertension. Twenty-one consecutive pre gnant women with gestational hypertension and 21 normotensive women matched for age and gestational age were enrolled in the third trimester of gestat ion. Echocardiographic and uterine color Doppler evaluations were performed . Systolic, diastolic, and mean blood pressure, total vascular resistance ( TVR), and uterine resistance index were higher in hypertensive women than i n control subjects (P<0.01). Left atrial function and cardiac output were s ignificantly lower in gestational hypertension (P<0.01). Patients with gest ational hypertension had longer left ventricular isovolumetric relaxation t ime (IVRT) (P<0.0001); lower velocity-time integral of the A wave (P<0.05) and of the diastolic pulmonary vein flow (P<0.05); and higher velocity-time integral of the reverse pulmonary vein flow (P<0.05), Systolic fraction of the pulmonary vein flow was higher in women with gestational hypertension than in control subjects (P<0.01); the difference in duration of pulmonary vein flow and A wave was closer to 0 in gestational hypertension (P<0.0001) , Altered left ventricular geometry was found in 100% of hypertensive patie nts and in 19.05% of normotensive patients (P<0.001). IVRT, left ventricula r end-systolic volume, atrial function, and uterine resistance index were d irectly related to TVR (P<0.01); deceleration time of the E wave showed a q uadratic correlation with TVR (P<0.01). Gestational hypertension is charact erized by an altered cardiac geometric pattern of concentric hypertrophy. T he altered geometric pattern assessed during gestational hypertension is as sociated, in our study, with depressed systolic function, high TVR, altered diastolic function, and left atrial dysfunction. Deceleration time of the E wave, IVRT, and left atrial fractional area change, found in concomitance with the highest TVR, may be useful in the evaluation of cardiac function and hemodynamics present in pregnancy-induced hypertension.