Comprehensive Assessment of Biventricular and Biatrial Myocardial Strain Parameters at Six Years Postpartum in a Cohort of Women with Previous Hypertensive Disorders of Pregnancy

Abstract

Background: Over the past decade, few echocardiographic investigations have assessed myocardial strain parameters in women with a history of hypertensive disorders of pregnancy (HDP), and their findings have been inconsistent. Moreover, no study has comprehensively evaluated deformation indices of all biventricular and biatrial chambers in women post-HDP. This study aimed to examine the structural and functional myocardial properties of all cardiac chambers in a cohort of women with prior HDP at six years after delivery. Methods: We analyzed a consecutive cohort of women with previous HDP and compared them with a control group of normotensive healthy women matched for age and body mass index (BMI). Both groups underwent standard transthoracic echocardiography (TTE) supplemented by a detailed speckle tracking echocardiography (STE) evaluation of biventricular and biatrial myocardial deformation, along with carotid ultrasound, at six years postpartum. The primary endpoint was subclinical myocardial dysfunction, defined by impaired left ventricular global longitudinal strain (LV-GLS < 20%), while the secondary endpoint was early carotid atherosclerosis, defined by common carotid artery intima-media thickness (CCA-IMT) ≥ 0.7 mm. Results: The study included 31 women with previous HDP (mean age 42.3 ± 5.9 years) and 30 matched controls without HDP history (mean age 40.8 ± 5.0 years). The average follow-up duration was 6.1 ± 1.3 years postpartum. Despite preserved and comparable systolic function on conventional TTE, most myocardial strain and strain rate measures in both ventricles and atria were significantly reduced in the HDP group compared to controls. Subclinical myocardial dysfunction was detected in 58.1% of women with prior HDP, and 67.7% exhibited increased CCA-IMT (≥0.7 mm). A history of pre-eclampsia (PE) was independently associated with subclinical myocardial dysfunction (HR 4.01, 95% CI 1.05-15.3, p = 0.03). Both third-trimester BMI (HR 1.21, 95% CI 1.07-1.38, p = 0.003) and PE (HR 6.38, 95% CI 1.50-27.2, p = 0.01) independently predicted early carotid atherosclerosis. Notably, a third-trimester BMI above 27 kg/m² showed optimal sensitivity and specificity for identifying the secondary outcome. Conclusions: A history of PE is independently associated with a higher risk of subclinical myocardial dysfunction and early carotid atherosclerosis at six years postpartum.

Keywords: previous hypertensive disorders of pregnancy; previous pre-eclampsia; speckle tracking echocardiography; subclinical carotid atherosclerosis; subclinical myocardial dysfunction.

Figure 1

Illustrations of right ventricular global longitudinal strain (A), left ventricular global longitudinal strain (B), right atrial reservoir strain (C), and left atrial reservoir strain (D) measurements obtained from the apical four-chamber view in a pHDP patient from this study. All myocardial strain values are decreased relative to the established reference ranges. GLS, global longitudinal strain; LASr, left atrial reservoir strain; LV, left ventricular; pHDP, previous hypertensive disorder of pregnancy; RASr, right atrial reservoir strain; RV, right ventricular.

Figure 2

Examples of LV-GLS bull’s-eye plots obtained in a pHDP woman with a history of pregnancy complicated by obesity and PE (A) and in a woman with previous uncomplicated pregnancy (B), respectively. GLS, global longitudinal strain; LV, left ventricular; PE, pre-eclampsia; pHDP, previous hypertensive disorder of pregnancy.

Figure 3

ROC curve analysis conducted to determine the sensitivity and specificity of third-trimester BMI in predicting the secondary outcome throughout the follow-up period. AUC, area under curve; BMI, body mass index; ROC, receiver operating characteristics.