Why the study?
Hypertensive pregnancy disorders increase long-term cardiovascular disease risk, but whether speckle tracking echocardiography can detect preclinical cardiac function differences during or after pregnancy was unclear.
Does speckle tracking echocardiography detect differences in cardiac function in women with current or prior hypertensive pregnancy disorders compared to normotensive controls?
Does speckle tracking echocardiography detect differences in cardiac function in women with current or prior hypertensive pregnancy disorders compared to normotensive controls?
Speckle tracking echocardiography reveals that hypertensive pregnancy disorders, particularly early-onset preeclampsia, are associated with significant and lasting subclinical myocardial dysfunction.
STE detects LV-GLS differences in HPD; extends evidence for early cardiac monitoring and warrants prospective outcome trials.
Importance Hypertensive pregnancy disorders (HPDs) are associated with an increased risk of long-term cardiovascular disease. Speckle tracking echocardiography (STE) might be useful in the early detection of preclinical cardiac changes in women with HPDs. Objective The aim of this study was to study whether STE is a suitable method to detect differences in cardiac function in pregnant women with HPD compared with normotensive pregnant women or between women with a history of a pregnancy complicated by HPD compared with women with a history of an uncomplicated pregnancy. Evidence Acquisition The databases Medline, EMBASE, and Central were systematically searched for studies comparing cardiac function measured with STE in pregnant women with HPD or women with a history of HPD and women with a history of normotensive pregnancies. Results The search identified 16 studies, including 870 women with a history of HPD and 693 normotensive controls. Most studies during pregnancy (n = 12/13) found a decreased LV-GLS (left ventricular global longitudinal strain) in HPD compared with normotensive pregnant controls. LV-GRS (left ventricular global radial strain) and LV-GLCS (left ventricular global circumferential strain) are decreased in women with early-onset and severe preeclampsia. Women with a history of early-onset preeclampsia show lasting myocardial changes, with significantly decreased LV-GLS, LV-GLCS, and LV-GRS. Conclusions and Relevance LV-GLS is significantly decreased in pregnant women with HPD compared with normotensive pregnant women. Other deformation values show a significant decrease in women with severe or early-onset preeclampsia, with lasting myocardial changes after early-onset preeclampsia. Target Audience Obstetricians and gynecologists, family physicians, cardiologists. Learning Objectives After participating in this activity, the learner should be better able to identify the test characteristics of STE; describe the differences in STE between HPDs and normotensive pregnant controls; and explain which HPD causes lasting myocardial changes after pregnancy.
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Moors et al. (2020) studied this question.
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