Related Experiment Video
Updated: Jun 22, 2025
Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
Echocardiographic Differences in Women Across Subtypes of Hypertensive Disorders of Pregnancy
Laith Alhuneafat1,2, Nada Alrifai1, Richard Amoateng1
1Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Insights
Hypertensive disorders of pregnancy (HDP) impact heart structure and function, with superimposed preeclampsia (SPE) showing the most significant echocardiographic changes. Early echocardiography can detect these abnormalities in high-risk pregnancies.
Area of Science:
- Cardiology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Hypertensive disorders of pregnancy (HDP) encompass gestational hypertension, preeclampsia (PRE), and chronic hypertension with superimposed preeclampsia (SPE).
- These conditions pose significant risks to maternal and fetal health.
- Understanding cardiac implications is crucial for managing HDP.
Purpose of the Study:
- To retrospectively analyze echocardiographic differences in biventricular structure and function among women with different types of HDP.
- To compare these findings with normotensive pregnant controls.
Main Methods:
- Retrospective analysis of echocardiograms from women during or within one year postpartum.
- Inclusion of 706 subjects (427 cases, 279 controls), categorized into gestational hypertension, PRE, and SPE groups.
- Exclusion of patients with specific comorbidities like pulmonary embolism, malignancy, autoimmune disease, or structural heart disease.
Main Results:
- Significant, graded differences in echocardiographic parameters were observed across HDP groups compared to controls.
- Left ventricular (LV) mass index and E/e' were highest in the SPE group, indicating more profound cardiac remodeling.
- Abnormalities in LV mass index and diastolic filling (E/e') were most pronounced in SPE and PRE.
Conclusions:
- Left ventricular remodeling and diastolic dysfunction are prevalent in HDP, particularly in SPE and PRE.
- Echocardiography during or shortly after pregnancy can identify cardiac abnormalities in high-risk women.
- Further research is needed to determine the long-term consequences of these echocardiographic findings.
Background:
Hypertensive disorders of pregnancy (HDP) can be classified into gestational hypertension, preeclampsia (PRE), and chronic hypertension with superimposed preeclampsia (SPE).
Objectives:
The purpose of this study was to retrospectively examine the echocardiographic differences in biventricular structure and function in 3 HDP groups of women in comparison to normotensive pregnant controls.
Methods:
Women with an echocardiogram during or within the first year of pregnancy were identified within our integrated health network. Exclusion criteria included age <18 years, diagnosis of pulmonary embolism, malignancy, autoimmune disease, and structural heart disease.
Results:
We identified a total of 706 subjects (cases: n = 427, normotensive controls: n = 279). Cases were divided into 3 groups: gestational hypertension (n = 57), PRE (n = 291), and SPE (n = 79). In adjusted analyses, echocardiographic parameters demonstrated a graded difference in left ventricular (LV) mass index, relative wall thickness, mitral inflow E, mitral inflow A, septal e', lateral e', E/e', left atrial volume index, tricuspid velocity, and lateral e' velocities with the most profound findings noted in the SPE group. Specifically, adjusted LV mass index (adjusted β = 14.45, 95% CI: 9.00-19.90) and E/e' (adjusted β = 2.97, 95% CI: 2.27-3.68) was highest in the SPE group in comparison to controls (P < 0.001).
Conclusions:
LV remodeling and diastolic filling abnormalities are more common in HDP and are most evident in SPE and PRE. Echocardiography during or immediately after pregnancy may be useful in these high-risk women to identify these abnormalities. The long-term implications of these echocardiographic abnormalities require further study.
Related Concept Videos
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...