| Division of Cardiology, Maryknoll General Hospital¹ , Busan, Korea; Division of Cardiology, College of Medicine, Inje University, Paik Hospital², Busan, Korea |
Background: Chronic hypertension induces changes in the cardiac structure and function. However,the effects of transient hypertension are unclear. Pregnancy-induced hypertension(PIH) offers a natural and spontaneous model of this condition. Methods: We studied 20 women aged 30.3±5.1 years with PIH defined as blood pressure higher than 140/90mmHg in the third trimester of pregnancy without a history of hypertension. 20 normal pregnant women(NPW), aged 30.9±3.7 years, were the controls. Cardiac chamber dimensions, interventricular septal thickness(IVST), posterior wall thickness(PWT), left ventricular mass index(LVMI), relative wall thickness(RWT), E velocity, A velocity, E/A ratio, isovolumetric relaxation time (IVRT), isovolumetric contraction time (ICT), ejection time(ET), and the Tei index(IVRT+ICT/ET) were calculated by echocardiography. Subjects were considered to have: normal geometry(NG) if both LVM and RWT were normal(LVMI<110g/m2, RWT<0.45); concentric hypertrophy(CH) if both were elevated; eccentric hypertrophy(EH) if LVMI was elevated and RWT was normal; and concentric remodeling(CR) if LVMI was normal and RWT was elevated. Results: There were statistically significant differences between groups in the following parameters; IVST: 10.5±1.3mm in PIH vs 8.6±1.0 mm in NPW (P<0.0001), PWT: 10.0±1.4mm in PIH vs 8.9±0.9mm in NPW (P<0.005), LVMI: 113.1±20.3g/m2 in PIH vs 85.9±14.5g/m2 in NPW(P<0.0001), RWT: 0.41±0.08 in PIH vs 0.35±0.03 in NPW (P<0.005), E/A ratio: 0.95±0.29 in PIH v 1.56±0.27 in NPW(P<0.0001), IVRT: 118.8±19.5msec v 83.1±12.4msec (P<0.0001), and the Tei index: 0.51±0.09 vs 0.31±0.06 (P<0.0001), respectively. The geometric pattern of PIH was NG in 4(20%), and abnormal in 16(80%), of which 10(50%) had EH. The geometric pattern of NPW was NG in 19(95%), and EH in 1(5%). Conclusion: PIH increases the LVMI due to an increase in the IVST and PWT and the most frequent abnormal geometric pattern was EH. The dimensions of the left ventricle, left atrium, and aortic root were not changed. PIH showed left ventricular dysfunction, mainly diastolic. The IVRT and the Tei index are the most useful echocardiographic parameters to reveal left ventricular dysfunction in PIH.
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