Hemodynamic maladaptation and left ventricular dysfunction in chronic hypertensive patients at the beginning of gestation and pregnancy complications: a case control study

Objective The aim of this study was to evaluate early pregnancy differences in maternal hemodynamics, cardiac geometry and function, between chronic hypertensive (CH) patients with and without the development of feto-maternal complications later in pregnancy. Methods We performed a case-control study on nulliparous CH treated patients. From a group of CH patients referred to our outpatient clinic at 4-6 weeks for a clinical evaluation the first consecutive 30 patients with subsequent complications (superimposed PE, abruptio placentae, uncontrolled severe hypertension with delivery <34 weeks, HELLP syndrome, FGR, perinatal death) were enrolled; the first 2 CH women with uneventful pregnancy referred after the case were enrolled as controls for a total of 60 patients. All patients were shifted to alpha-methyl dopa at the beginning of pregnancy and were submitted to an echocardiographic evaluation to assess the maternal hemodynamics, cardiac geometry, diastolic and systolic function. Results Patients developing complications had a lower early pregnancy heart rate (73 +/- 11 vs. 82 +/- 11 bpm), cardiac output (5.23 +/- 1.2 vs. 6.5 +/- 1.3 L/min,p<.01) and cardiac index (3.0 +/- 0.7 vs. 3.6 +/- 0.7 L/min/m(2),p<.01); higher total vascular resistance (1554 +/- 305 vs. 1248 +/- 243 d.s.cm(-5),p<.01) and total vascular resistance index (2666 +/- 519 vs. 2335 +/- 431, d.s.cm(-5)/m(2),p<.01); higher left ventricular mass index (42.1 +/- 8.6 vs. 36.9 +/- 8.3 g/m(2),p<.01) and relative wall thickness (0.40 +/- 0.05 vs. 0.36 +/- 0.05,p<.01) of the left ventricle, resulting in a higher prevalence of altered cardiac geometry vs. uneventful CH controls. Diastolic and systolic dysfunction were also present with a higher E/e ' ratio (10.50 +/- 3.56 vs. 7.22 +/- 1.91,p<.01) and a lower stress corrected midwall mechanics (89 +/- 21 vs. 100 +/- 22,p=.02) of the left ventricle. Conclusion CH treated patients developing maternal and/or fetal complications show early pregnancy altered cardiac geometry, diastolic and systolic dysfunction, and impaired hemodynamics with a high resistance circulation.