Maternal hemodynamic findings as a tool to predict the risk of Left Ventricular Hypertrophy (LVH) in pregnant women with chronic hypertension (CH)

Objective. To evaluate the accuracy of hemodynamic parameters in predicting the risk of LVH in women with CH.
Materials and Methods. A prospective study including a cohort of singleton pregnancies with a diagnosis of CH according to ISSHP guidelines. A non-invasive hemodynamic evaluation by USCOM-1A and a trans-thoracic echocardiography were performed before 16 weeks of gestation. We also calculated the ratio between the Mean Arterial Pressure and the maternal Heart Rate (MAP/HR Ratio). LVH was diagnosed when Left Ventricular Mass Index was over 95 g/m². An adverse pregnancy outcome (APO) was defined in presence of one of the following complications: delivery < 32 weeks, superimposed preeclampsia, Intrauterine Growth Restriction, stillbirth.
Results. 49 women were included. Cardiac Output and Systemic Vascular Resistance showed the highest accuracy in predicting the risk of LVH (AUC 94.4 95%CI 0.86-0.99 cut-off 5.8 and AUC 94.0% 95%CI 0.86-0.99 cut-off 1387, respectively). The MAP/HR ratio also showed a good accuracy (AUC 80.6 95%CI 0.68-0.93, cut-off 1.20) while maternal age showed a fair accuracy (AUC 71.8%, 95%CI 0.57-86.0, cut-off 37.0). The incidence of an APO was significantly higher in those women with LVH (50% vs 18.5%, p = 0.019, OR 4.4, 95%CI 1.2-15.8).
Conclusions. Hemodynamic parameters by USCOM-1A can stratify the risk of pregnant woman with CH in presenting LVH and to identity those who are likely to have an increased risk of an APO.