The effect of cardiac phenotypes on the course and outcomes of pregnancy among patients with hypertensive disorders

• Bakhtykei M. Gasanova
• Miroslava L. Polina
• Agamurad A. Orazmuradov

Abstract

Aim - to study the effect of cardiac phenotypes of pregnant women with chronic arterial hypertension (CAH) and the development of preeclampsia (PE) on its background on the course and outcomes of pregnancy.

Material and methods. The study included 376 pregnant women with CAH: 1^st group - with isolated one (n=172), 2^nd group - with the development of PE on its background (n=172), a control group - with physiological pregnancy (PhP) (n=34). The scope of examination: blood pressure measurement - office and daily monitoring (DBPM), echocardiography, doppler echocardiography - traditional and tissue myocardial (TMDop-plerEC), dopplerometry of the utero-fetal placental blood flow (UFPBF).

Results. High frequency of the following disorders was determined: placental insufficiency (PI), fetal growth retardation, premature birth, the number of newborns with low Apgar scores, newborns' low weight in the group with PE on the CAH background compared with isolated hypertension. High perinatal morbidity was shown in hypertensive disorders.

The study proved the effectiveness of complex examination of pregnant women with CAH which included DBPM, echocardiography, tissue myocardial Doppler echocardiography, dopplerometry of the utero-fetal placental blood flow, in predicting gestational complications, PE and severe hypertension. PE predictors on the CAH background were the reduction of daily index (DI) (belonging to the night pickers), the increase in average night blood pressure (due to diastolic component).

Prognostic importance of assessing options of cardioremodeling and LV diastolic dysfunction increased with a disproportionately high mass of the left myocardium ventricle (LVM). The presence of disproportionality coefficient (DC >128) caused a large frequency of LV concentric hypertrophy: twice as much - in the II trimester, almost four times - in the III trimester, excessive "rigidity" of LV myocardium among pregnant women with hypertension. The efficiency of diagnosing diastolic blood pressure relaxation type increased in the presence of tissue Doppler echocardiography compared with traditional: in the II trimester - almost three times with CAH, twice - with PE on the CAH background; in the III trimester - almost two and four times, respectively. The early appearance of DF disorders turned out to be a prognostically adverse factor in groups with the change of LV morphostructures according to the type of concentric hypertrophy (27.5%). The influence of the LV geometric model type on pregnancy outcomes showed the following results: placental insufficiency (PI), fetal growth retardation, violations of the utero-fetal-placental blood flow, premature birth, Apgar low scores (less than 7), newborns' hypotrophy were observed more often with concentric hypertrophy.

Conclusion. Assessing gestational risks, complications and adverse perinatal outcomes in CAH is based on the results of a comprehensive study of organs-targets (the nature of LV and "mother-placenta-fetus" cardio-reconstruction). Highlighting risk groups indicates the need to monitor and implement medical preventive measures from early pregnancy.

Design: An open, prospective study.

Keywords:chronic arterial hypertension hypertension in pregnancy, preeclampsia, LV myocardium geometry, LV diastolic dysfunction, perinatal outcomes, daily blood pressure monitoring

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