Key result
Hypertensive disorders of pregnancy linked to ~1.2-point worse postpartum GLS vs controls.
Why the study?
Hypertensive disorders of pregnancy (HDP) are associated with increased long-term maternal cardiovascular risk, but it remained unclear whether subclinical echocardiographic systolic dysfunction is already present in the postpartum period.
Does a history of hypertensive disorders of pregnancy impair postpartum left ventricular systolic function (GLS and LVEF) compared to controls?
Meta-Analysis (n=1,589)
Does a history of hypertensive disorders of pregnancy impair postpartum left ventricular systolic function (GLS and LVEF) compared to controls?
Women with a history of hypertensive disorders of pregnancy, particularly preeclampsia, exhibit early subclinical left ventricular systolic dysfunction in the postpartum period predominantly detected by reduced global longitudinal strain, supporting the use of echocardiographic strain imaging for early cardiovascular risk stratification.
Impaired postpartum GLS after hypertensive disorders of pregnancy suggests subclinical dysfunction; leaves open its role in long-term risk stratification.
Introduction Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia (PE), are associated with an increased long-term risk of maternal cardiovascular disease. However, whether subclinical cardiac changes with echocardiographic systolic dysfunction are already present in the postpartum period remains unclear. Purpose We aimed to conduct a systematic review and meta-analysis evaluating echocardiographic systolic dysfunction in the postpartum period among women with HDP. Methods A systematic search was conducted in PubMed, Embase, and Cochrane database for studies evaluating left ventricular systolic dysfunction in postpartum period in women with HDP. Global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF) were extracted for women with HDP and PE. Pooled mean differences (MD) were estimated using a random-effects model, with a significance level of 0.05. Confidence interval (CI) of 95% was adopted and heterogeneity was accessed using I². Statistical analysis was conducted using RevMan. Results Thirteen observational studies were included, with 1.589 patients. Postpartum GLS was significantly impaired in women with previous HDP compared with controls (MD 1.23 [CI 95%: 0.60 to 1.85]; p=0.0001; I² 65% - Figure 1A) and also in women with PE (MD 2.39 [CI 95%: 1.48 to 3.29]; p<0.00001; I² 29% - Figure 1B). LVEF did not differ significantly between women with previous HDP and controls (MD -0.35 [CI 95%: -1.09 to 0.39]; p=0.36; I² 5% - Figure 2A), but was significantly reduced in women with previous PE compared with controls (MD -2.76 [CI 95%: -4.61 to -0.90]; p=0.004; I² 46% - Figure 2B). Conclusions Women with a history of hypertensive disorders of pregnancy exhibit impaired postpartum left ventricular systolic function, predominantly detected by reduced GLS. These findings indicate the presence of early, subclinical systolic dysfunction after HDP, particularly following PE, supporting the role of echocardiographic strain imaging for early cardiovascular risk stratification in this population.Figure 1Figure 2
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Carvalho et al. (2026) conducted a meta-analysis in Hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia) (n=1,589). Hypertensive disorders of pregnancy (including preeclampsia) vs. Controls without hypertensive disorders of pregnancy was evaluated on Postpartum global longitudinal strain (GLS) (MD 1.23, 95% CI 0.60-1.85, p=0.0001). Hypertensive disorders of pregnancy were associated with impaired postpartum global longitudinal strain compared with controls (MD 1.23; 95% CI 0.60-1.85; p=0.0001).
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