POSTPARTUM STRUCTURAL MYOCARDIAL CHANGES IN WOMEN WITH HYPERTENSION DURING PREGNANCY
https://doi.org/10.18705/1607-419X-2014-20-4-325-332
Abstract
Objective. To assess the dynamics of cardiac remodeling after childbirth in various forms of hypertension (HT) during pregnancy.
Design and methods. Altogether 130 pregnant women with hypertension aged 20 to 40 years (mean age 26,1 ± 1,7 years) at the 28–32 week of gestation pregnancy were examined. The control group consisted of 30 pregnant women with normal values of blood pressure (BP). Two-fold offi ce BP measurement, ambulatory BP monitoring (ABPM), heart ultrasound were performed in all women. After 12 weeks of delivery the examination was repeated.
Results. Chronic hypertension (CAH) was diagnosed in 43 % of surveyed pregnant women with hypertension. This group of patients had higher BP at ABPM and offi ce BP as compared to gestational hypertension (GAH). The frequency of myocardial changes was also higher in this group: left ventricular hypertrophy (LVH) was found in 26 %, LV concentric remodeling (LVCR) — in 42 %, and these changes remained 12 weeks post-delivery. In patients with GAH there were only LVCR signs (29 %) that reversed after childbirth. Cardiac remodeling of different severity and stability was found in all groups studied. CAH was characterized by higher values of office BP and ABPM parameters as compared with GAH and was accompanied by marked and persistent heart changes (through 12 weeks postpartum). There was slight increase in myocardial mass and LV volume in the group of pregnant women without hypertension, but these changes did not go beyond the normal range.
Conclusion. Timely and complete examination of pregnant women with hypertension, including ABPM and heart ultrasound, will improve early diagnosis of essential hypertension and timely management, as well as complication prevention.
About the Authors
E. B. Savinova
North-West State Medical University named after I.I. Mechnikov, St Petersburg
Russian Federation
Russian Federation
Corresponding author: North-West State Medical University named after I.I. Mechnikov, 41 Kirochnaya st., St Petersburg, Russia, 197341. E-mail: elena-n@yandex.ru (Elena B. Savinova, MD, Postgraduate Student of the Department of Internal Diseases at the North-West State Medical University named after I.I. Mechnikov).
L. A. Sokolova
Federal Almazov Medical Research Centre, St Petersburg
Russian Federation
Russian Federation
E. L. Nezhentseva
North-West State Medical University named after I.I. Mechnikov, St Petersburg
Russian Federation
Russian Federation
References
1. Диагностика и лечение артериальной гипертензии у беременных. Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов. — 2010. — [Электронный ресурс]. — URL: http://www.cardiosite.info/info.aspx?rubricid=13 (дата обращения — 20.09.2013) / Diagnostics and management of hypertension in pregnancy. Guidelines of the Russian Hypertension Society and Russian Cardiology Society. — 2010. — [Electronic resource]. — URL: http://www.cardiosite.info/info.aspx?rubricid=13 (access date: 20.09.2013) [Russian].
2. ESC Guidelines on the management of cardiovascular diseases during pregnancy. The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC) // Eur. Heart J. — 2011. — Vol. 32, № 24. — Р. 3147–3197.
3. Paradisi G., Biaggi A., Savone R. et al. Cardiovascular risk factors in healthy women with previous gestational hypertension // J. Clin. Endocrinol. Metab. — 2006. — Vol. 91, № 4. — Р. 1233–1238.
4. Evans C.S., Gooch L., Flotta D. et al. Cardiovascular system during the postpartum state in women with a history of preeclampsia // Hypertension. — 2011. — Vol. 58, № 1. — Р. 57–62.
5. Vlahović-Stipac A., Stankić V., Popović Z.B., Putniković B., Nesković A.N. Left ventricular function in gestational hypertension: serial echocardiographic study // Am. J. Hypertens. — 2010. — Vol. 23, № 1. — Р. 85–91.
6. Melchiorre K., Sutherland G.R., Baltabaeva A., Liberati M., Thilaganathan B. Maternal cardiac dysfunction and remodeling in women with preeclampsia at term // Hypertension. — 2011. — Vol. 57, № 1. — Р. 85–93.
7. Савинова Е.Б., Соколова Л.А., Сердюков С.В., Неженцева Е.Л. Возможности раннего выявления гипертонической болезни у беременных женщин // Клиницист. — 2012. — № 3. — С. 23–27. / Savinova E.B., Sokolova L.A., Serdyukov S.B., Nezhentseva E.L The opportunities of early diagnosis of hypertension in pregnancy // Clinician [Klinitsist]. — 2012. — № 3. — Р. 23–27 [Russian].
8. Савинова Е.Б., Соколова Л.А., Сердюков С.В., Неженцева Е.Л. Клиническая оценка структурно-функциональных изменений сердца и сосудов у беременных женщин с артериальной гипертензией // Вестн. СПГМУ им И.И. Мечникова. — 2012. — № 4. — С. 46–51. / Savinova E.B., Sokolova L.A., Serdyukov S.B., Nezhentseva E.L. Clinical assessment of structural and functional cardiovascular changes in pregnant women with hypertension // Bulletin of North-West State Medical University named after I.I. Mechnikov [Vestnik SPGMU im. I.I. Mechnikova]. — 2012. — № 4. — Р. 46–51 [Russian].
9. Синицын С.П., Чулков В.С., Вереина Н.К. Артериальная гипертензия у беременных и с факторами тромбогенного риска: особенности течения различных клинических форм, состояние органов-мишеней и показатели гемостаза // Артериальная гипертензия. — 2009. — Т. 15, № 5. — С. 580–584. / Sinitsin S.P., Chulkov V.S., Vereina N.K. Hypertension in pregnant females with the risk of thrombogenicity: clinical forms, target organs damage and hemostatic parameters // Arterial Hypertension [Arterialnaia Gipertenziia]. — 2009. — Vol. 15, № 5. — Р. 580–584 [Russian].
10. Devereux R.B., Savage D.D., Sachs I., Laragh J.H. Relation of hemodynamics load to left ventricular hypertrophy and performance in hypertension // Am. J. Cardiol. — 1983. — Vol. 51, № 1. — Р. 171–176.
11. de Simone G., Devereux R.B., Koren M.J., Mensah G.A., Casale P.N., Laragh J.H. Midwall left ventricular mechanics: an independent predictor of cardiovascular risk in arterial hypertension // Circulation. — 1996. — Vol. 93, № 2. — Р. 259–265.
12. Vasapollo B., Novelli G.P., Valensise H. Total vascular resistance and left ventricular morphology as screening tools for complications in pregnancy // Hypertension. — 2008. — Vol. 51, № 4. — Р. 1020–1026.
13. Ткачева О.Н., Барабашкина А.В. Актуальные вопросы патогенеза, диагностики и фармакотерапии артериальной гипертонии у беременных. — М.: Пагри, 2006. — 140 с. / Tkacheva O.N., Barabashkina A.V. Relevant issues of pathogenesis, diagnostics and pharmacotherapy of hypertension in pregnancy. — Moscow: Pagri, 2006. — 140 p. [Russian].
14. Novelli G.P., Valensise H., Vasapollo B. et al. Left ventricular concentric geometry as a risk factor in gestational hypertension // Hypertension. — 2003. — Vol. 41, № 3. — Р. 469–475.
15. Valensise H., Vasapollo B., Novelli G.P. et al. Maternal total vascular resistance and concentric geometry: a key to identify uncomplicated gestational hypertension // BJOG. — 2006. — Vol. 113, № 9. — Р. 1044–1052.
16. Савинова Е.Б., Соколова Л.А. Феномен изолированной клинической артериальной гипертензии («гипертонии белого халата») у беременных // Профилактическая и клиническая медицина. — 2011. — Т. 3, № 40. — С. 313–317. / Savinova E.B., Sokolova L.A. The phenomenon of isolated hypertension (white-coat hypertension) // Preventive and Clinical Medicine [Profi lakticheskaja i Klinicheskaja Meditsina]. — 2011. — Vol. 3, № 40. — Р. 313–317 [Russian].
17. Гайсин И.Р., Максимов Н.И. Ремоделирование сердца и сосудов у беременных с артериальной гипертонией // Морфологические ведомости. — 2008. — № 4. — С. 165–169. / Gaysin I.R., Maksimov N.I. Cardiovascular remodeling in pregnant women with hypertension // Pathological Gazette [Morfologicheskie Vedomosti]. — 2008. — № 4. — Р. 165–169 [Russian].
18. Блощинская И.А., Петричко Т.А., Давидович И.М. Вазорегулирующая функция сосудистого эндотелия при физиологической беременности и гестозе // Журн. акушерства и женских болезней. — 2003. — № 1. — С. 26–32. / Blosсhinskaya I.A., Petrichko T.A., Davydovich I.M. Endothelial vasoregulation in pregnancy and gestosis // Obstetrics and Gynecology [Zhurnal Akusherstva i Zhenskikh Bolezney]. — 2003. — № 1. — Р. 26–32 [Russian].
19. Мозговая Е.В., Малышева О.В., Иващенко Т.Э. и др. Эндотелиальная дисфункция при гестозе. Патогенез, генетическая предрасположенность, диагностика и профилактика. — СПб.: Издательство Н-Л, 2003. — 32 с. / Mozgovaja E.V., Malysheva O.V., Ivashchenko T.E. et al. Endothelial dysfunction in gestosis. Pathogenesis, genetics, diagnostics and prevention. — St Petersburg: N-L Publishing House, 2003. — 32 p. [Russian].
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For citations:
Savinova E.B., Sokolova L.A., Nezhentseva E.L. POSTPARTUM STRUCTURAL MYOCARDIAL CHANGES IN WOMEN WITH HYPERTENSION DURING PREGNANCY. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2014;20(4):325-332. (In Russ.) https://doi.org/10.18705/1607-419X-2014-20-4-325-332
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