Cardiac dysfunction during adverse maternal outcomes in hypertensive disorders of pregnancy

Abstract

Introduction: Hypertensive disorders of pregnancy are associated with significant cardiac remodeling and diastolic dysfunction during pregnancy and are important contributors to maternal morbidity and mortality. Whether acute adverse maternal outcomes during hypertensive disorders of pregnancy are associated with abnormal left ventricular geometry and function has not been widely studied.

Material and methods: A prospective observational study was conducted on 255 women with hypertensive disorders of pregnancy who underwent transthoracic echocardiography during the peripartum period. Maternal echocardiographic parameters, including left ventricular morphology and function, were analyzed to determine their association with composite adverse maternal outcomes by univariate and multivariate analyses. The composite adverse maternal outcome was defined as at least one of the following: admission to a high dependency unit (an intermediate-care ward, providing enhanced cardiac monitoring), acute renal injury, adverse cardiopulmonary events, stroke, and disseminated intravascular coagulation.

Results: Adverse maternal outcomes occurred in 68 (26.7%) participants. Women with adverse outcomes had significantly higher left atrial volume index (28.8 [23.4-32.3] mL/m² vs. 26.6 [22.2-30.9] mL/m², p = 0.045) and E/e' ratio (7.8 [6.6-9.2] vs. 7.0 [5.9-8.1], p = 0.002) compared to those without complications. Other diastolic indices, namely, mitral inflow E/A and tissue-Doppler e' velocities at the lateral and septal mitral annulus, showed no statistically significant between-group. In multivariable analysis, both left atrial volume index and E/e' ratio remained independently associated with adverse maternal outcomes after adjusting for maternal factors and clinical variables. Right ventricular indices, such as tricuspid annular plane systolic excursion and systolic velocity S', were independently associated with adverse maternal outcomes, while fractional area change remained unchanged, indicating hyperkinetic circulatory adaptation rather than enhanced intrinsic right systolic function.

Conclusions: Cardiac abnormalities, particularly in left ventricular diastolic function and in right ventricular function, are more common in women with adverse maternal outcomes in hypertensive disorders of pregnancy than in hypertensive women without adverse maternal outcomes. Further studies are needed to determine whether these echocardiographic abnormalities could help identify women at increased risk of complications.

Keywords: adverse maternal outcomes; hypertension; pregnancy; pre‐eclampsia; transthoracic echocardiography.