تقييم التغيرات في البطين الايسر للحوامل في الثلث الاخير من الحمل في حالة الضغط الطبيعي وارتفاع الضغط اثناء الحمل باستخدام جهاز صدى القلب == EVALUATION OF ECHOCARDIOGRAPHIC CHANGES OF LEFT VENTRICLE DURING THE THIRD TRIMESTER IN NORMOTENSIVE AND GESTATIONAL HYPERTENSION
Author name:
زينب عبد الخالق الركابي
Supervisor name:
غسان ثابت سعيد | غازي فرحان الحاجي
General topic:
Medicine
Specific topic:
Physiology
Degree:
Master
University:
University of Baghdad - Faculty Of Medicine
Language:
English
University location:
Baghdad
First pages:
19T1458 - p.pdf
Abstract:
Pregnancy is considered as the “nature’s silent stress test” as it challenges the maternal cardiovascular system to undergo several cardiovascular adaptations. At the same time, it may reveal some hidden cardiac diseases. Furthermore, maladaptation of the mother’s cardiovascular system to these challenges can leads to several obstetric complications, more commonly, gestational hypertension which is the main cause of maternal death.The aims of this study are : to assess the maternal left ventricular structure and function during the last trimester of pregnancy and to find the impact of gestational hypertension on the maternal heart using transthoracic echocardiography.This cross sectional study was carried out in Baghdad teaching hospital. A total of 215 women were studied and 200 of them were included, they were classified into three groups : 100 women with mean age (29.83± 5.33 year) with gestational hypertension defined as increased systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90mmHg emerging after 20 weeks of gestation with no proteinuria, were considered as gestational hypertensive women group (GHW), 50 normotensive pregnant women with normal singleton pregnancy and mean age (28 ± 3.18 year) matched for gestational age with gestational hypertensive women were considered as normal pregnant women (NPW) group and 50 nulliparous normotensive women aged (30.1 ± 5.03 year) served as controls. All omen were submitted to a detailed medical history and physical examination focusing on hypertension risk factors. Their blood pressure was measured in the left lateral decubitus position and their body weight, height were measured to calculate bodymass index and body surface area. The left ventricle structure and function were evaluated using transthoracic echocardiography. The results of this study revealed that Gravidity was significantly higher and parity was significantly lower in GHW group compared to NPW group (P= 0.001 and P= 0.004 respectively). GHW had significantly higher BMI and BSA and 63% of them had edema. NPW had significantly higher LVIDd, IVST, PWT and RWT than controls with no significant change in EF, they also had higher LVMI over controls (P= 0.002, P= 0.0001, P= 0.0003, P= 0.0001 and P= 0.0002). 76% had normal LV geometry, 20% had eccentric hypertrophy and 4% had concentric remodeling. They also had larger LA area with higher A wave velocity and E/A ratio (P= 0.001, P= 0.001, P= 0.0012) and longer IVRT (P= 0.00013) with no significant change in Tei index.GHW compared to NPW had significantly higher IVST, PWT and RWT (P= 0.0001, P= 0.0003, P= 0.0001) they also had higher LVMI (P= 0.00022). 59% had abnormal LV geometry; of which : 34% had eccentric hypertrophy, 19% had concentric hypertrophy and 6% had concentric remodeling. 41% had normal LV geometry.The A wave velocity and E/A ratio were higher in GHW (P= 0.001, P= 0.0012) with significantly lower é velocity and higher E/é ratio (P= 0.0002 and P= 0.00012). Their IVRT and IVCT were significantly longer (P= 0.00013, P= 0.0003), with higher Tei index value (mean 0.56034 ± 0.07487) and P value of 0.001.In conclusion, pregnancy causes volume overload on the left ventricle which adapts through physiological hypertrophy with no further effect on the systolic and diastolic function of the heart. While, gestational hypertension adds the effect of pressure overload leading to further LV hypertrophy and remolding and might cause Grade I diastolic dysfunction.
