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(Hypertension. 2001;37:1209.)
© 2001 American Heart Association, Inc.

Scientific Contributions

Maternal Diastolic Dysfunction and Left Ventricular Geometry in Gestational Hypertension

Herbert Valensise; Gian Paolo Novelli; Barbara Vasapollo; Giancarlo Di Ruzza; Maria Elisabetta Romanini; Massimo Marchei; Giovanni Larciprete; Dario Manfellotto; Carlo Romanini; Alberto Galante

From the Department of Obstetrics and Gynecology (H.V., B.V., M.E.R., G.L., C.R.) and the School of Cardiology, Semeiology, and Medical Methodology, San Raffaele Hospital Velletri (G.P.N., G.D.R., M.M., A.G.), Tor Vergata University, Rome, Italy; and AfaR-CRCCS–Associazione Fatebenefratelli per la ricerca–Centro di Ricovero e Cura a Carattere Scientifico–Ospedale Fatebenefratelli Isola Tiberina (D.M.), Rome, Italy.

Correspondence to Herbert Valensise, Ospedale S. Giovanni Calibita Fatebenefratelli, Divisione di Ginecologia ed Ostetricia, Università di Roma Tor Vergata, Isola Tiberina 39, 00186 Rome, Italy. E-mail valensise{at}med.uniroma2.it

Abstract—The objective of this study was to evaluate diastolic parameters and left ventricular geometry in gestational hypertension. Twenty-one consecutive pregnant women with gestational hypertension and 21 normotensive women matched for age and gestational age were enrolled in the third trimester of gestation. Echocardiographic and uterine color Doppler evaluations were performed. Systolic, diastolic, and mean blood pressure, total vascular resistance (TVR), and uterine resistance index were higher in hypertensive women than in control subjects (P<0.01). Left atrial function and cardiac output were significantly lower in gestational hypertension (P<0.01). Patients with gestational hypertension had longer left ventricular isovolumetric relaxation time (IVRT) (P<0.0001); lower velocity-time integral of the A wave (P<0.05) and of the diastolic pulmonary vein flow (P<0.05); and higher velocity-time integral of the reverse pulmonary vein flow (P<0.05). Systolic fraction of the pulmonary vein flow was higher in women with gestational hypertension than in control subjects (P<0.01); the difference in duration of pulmonary vein flow and A wave was closer to 0 in gestational hypertension (P<0.0001). Altered left ventricular geometry was found in 100% of hypertensive patients and in 19.05% of normotensive patients (P<0.001). IVRT, left ventricular end-systolic volume, atrial function, and uterine resistance index were directly related to TVR (P<0.01); deceleration time of the E wave showed a quadratic correlation with TVR (P<0.01). Gestational hypertension is characterized by an altered cardiac geometric pattern of concentric hypertrophy. The altered geometric pattern assessed during gestational hypertension is associated, in our study, with depressed systolic function, high TVR, altered diastolic function, and left atrial dysfunction. Deceleration time of the E wave, IVRT, and left atrial fractional area change, found in concomitance with the highest TVR, may be useful in the evaluation of cardiac function and hemodynamics present in pregnancy-induced hypertension.

Key Words: hypertension, gestational • diastole • ventricular function, left

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