Left atrial structure and function: association with blood pressure variability in pregnant women.
Journal
Blood pressure monitoring
ISSN: 1473-5725
Titre abrégé: Blood Press Monit
Pays: England
ID NLM: 9606438
Informations de publication
Date de publication:
01 Feb 2023
01 Feb 2023
Historique:
pubmed:
7
1
2023
medline:
10
1
2023
entrez:
6
1
2023
Statut:
ppublish
Résumé
The aim of this study was to investigate the relationship between left atrial (LA) abnormalities and ambulatory blood pressure variability (BPV) in pregnant women and their relationship with hypertension-related clinical outcomes in pregnancy. This single-center, prospective study included 119 pregnant women. All participants underwent 24-h ambulatory blood pressure (BP) monitoring and echocardiographic examination before 20 weeks of gestation. BPV was evaluated using 24-h ambulatory BP monitoring. SD of the mean of SBP (SBP-SD) and DBP variability was calculated as 24-h, daytime and nighttime SBP and DBP. The patients were classified into two groups based on median 24-h SBP-SD (11.3 mmHg). LA features of the patients were compared according to the high and low BPV groups. One hundred and nineteen pregnant women (mean age, 28.6 ± 5.2 years) were included in the study. The mean office SBP and DBP were 108.7 ± 15.4 mmHg and 68.2 ± 10.2 mmHg, respectively. In pregnant women with high BPV, even though BP is normal, reservoir and conduit LA functions have decreased and LA stiffness has increased. Gestational hypertension and composite outcomes were more common in pregnant women with high BPV. Among the LA parameters, the most associated with composite outcome was conduit LA function. In pregnancy, higher BPV is associated with worse LA function. The LA conduit strain offers potential value in predicting hypertension-related clinical outcomes in pregnancy.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study was to investigate the relationship between left atrial (LA) abnormalities and ambulatory blood pressure variability (BPV) in pregnant women and their relationship with hypertension-related clinical outcomes in pregnancy.
METHODS
METHODS
This single-center, prospective study included 119 pregnant women. All participants underwent 24-h ambulatory blood pressure (BP) monitoring and echocardiographic examination before 20 weeks of gestation. BPV was evaluated using 24-h ambulatory BP monitoring. SD of the mean of SBP (SBP-SD) and DBP variability was calculated as 24-h, daytime and nighttime SBP and DBP. The patients were classified into two groups based on median 24-h SBP-SD (11.3 mmHg). LA features of the patients were compared according to the high and low BPV groups.
RESULTS
RESULTS
One hundred and nineteen pregnant women (mean age, 28.6 ± 5.2 years) were included in the study. The mean office SBP and DBP were 108.7 ± 15.4 mmHg and 68.2 ± 10.2 mmHg, respectively. In pregnant women with high BPV, even though BP is normal, reservoir and conduit LA functions have decreased and LA stiffness has increased. Gestational hypertension and composite outcomes were more common in pregnant women with high BPV. Among the LA parameters, the most associated with composite outcome was conduit LA function.
CONCLUSION
CONCLUSIONS
In pregnancy, higher BPV is associated with worse LA function. The LA conduit strain offers potential value in predicting hypertension-related clinical outcomes in pregnancy.
Identifiants
pubmed: 36606478
doi: 10.1097/MBP.0000000000000626
pii: 00126097-202302000-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
42-46Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Graves CR, Davis SF. Cardiovascular complications in pregnancy: it is time for action. Circulation 2018; 137:1213–1215.
Tadic M, Cuspidi C, Suzic-Lazic J, Vukomanovic V, Mihajlovic S, Savic P, et al. Blood-pressure variability is associated with left-ventricular mechanics in patients with gestational hypertension and preeclampsia. Hypertens Res 2021; 44:1625–1632.
Orabona R, Sciatti E, Prefumo F, Vizzardi E, Bonadei I, Valcamonico A, et al. Pre-eclampsia and heart failure: a close relationship. John Wiley & Sons, Ltd; 2018. pp. 297–301.
Liu X, Duan K, Zhu F, Zhang H, Zhang S. Observation of changes in left atrial and left ventricular function in patients with hypertensive disorders of pregnancy based on myocardial strain. Ann Palliat Med 2021; 10:606–614.
AbdelWahab MA, Farrag HM-A, Saied CE. 24-hour blood pressure variability as a predictor of short-term echocardiographic changes in normotensive women with past history of preeclampsia/eclampsia. Pregnancy Hypertens 2018; 13:72–78.
Liu J, Yang L, Teng H, Cao Y, Wang J, Han B, et al. Visit-to-visit blood pressure variability and risk of adverse birth outcomes in pregnancies in East China. Hypertens Res 2021; 44:239–249.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009; 10:165–193.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16:233–270.
D’Ascenzi F, Pelliccia A, Natali BM, Cameli M, Andrei V, Incampo E, et al. Increased left atrial size is associated with reduced atrial stiffness and preserved reservoir function in athlete’s heart. Int J Cardiovasc Imaging 2015; 31:699–705.
Ayala DE, Hermida RC. Ambulatory blood pressure monitoring for the early identification of hypertension in pregnancy. Chronobiol Int 2013; 30:233–259.
Brown MA. Is there a role for ambulatory blood pressure monitoring in pregnancy? Clin Exp Pharmacol Physiol 2014; 41:16–21.
Zhong L, Deng W, Zheng W, Yu S, Huang X, Wen Y, et al. The relationship between circadian blood pressure variability and maternal/perinatal outcomes in women with preeclampsia with severe features. Hypertens Pregnancy 2020; 39:405–410.
Kasim HH, Masri MA, Noh NA, Mokhtar A, Mokhtar RH. Clinical implications of blood pressure variability (BPV) in pregnancies: a review. Horm Mol Biol Clin Investig 2019; 39:1–13.
Ando T, Kaur R, Holmes AA, Brusati A, Fujikura K, Taub CC. Physiological adaptation of the left ventricle during the second and third trimesters of a healthy pregnancy: a speckle tracking echocardiography study. Am J Cardiovasc Dis 2015; 5:119–126.
Shahul S, Medvedofsky D, Wenger JB, Nizamuddin J, Brown SM, Bajracharya S, et al. Circulating antiangiogenic factors and myocardial dysfunction in hypertensive disorders of pregnancy. Hypertension 2016; 67:1273–1280.
Cho KI, Kim SM, Shin MS, Kim EJ, Cho EJ, Seo HS, et al. Impact of gestational hypertension on left ventricular function and geometric pattern. Circ J 2011; 75:1170–1176.
Ajmi H, Abid D, Milouchi S, Louati D, Sghaier A, Choura D, et al. Interest of speckle tracking in the detection of cardiac involvement in pregnant women with hypertensive disorder. Pregnancy Hypertens 2018; 11:136–141.
Liu W, Li Y, Wang W, Li J, Cong J. Layer-specific longitudinal strain analysis by speckle tracking echocardiography in women with early and late onset preeclampsia. Pregnancy Hypertens 2019; 17:172–177.
Tadic M, Cuspidi C, Pencic B, Mancia G, Grassi G, Kocijancic V, et al. Impact of different dipping patterns on left atrial function in hypertension. J Hypertens 2020; 38:2245–2251.
Demir M, Aktaş I, Yildirim A. Left atrial mechanical function and stiffness in patients with nondipper hypertension: a speckle tracking study. Clin Exp Hypertens 2017; 39:319–324.
Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, et al. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 2010; 3:231–239.
D’Andrea A, Caso P, Romano S, Scarafile R, Salerno G, Limongelli G, et al. Different effects of cardiac resynchronization therapy on left atrial function in patients with either idiopathic or ischaemic dilated cardiomyopathy: a two-dimensional speckle strain study. Eur Heart J 2007; 28:2738–2748.
Zhao Y, Sun Q, Han J, Lu Y, Zhang Y, Song W, et al. Left atrial stiffness index as a marker of early target organ damage in hypertension. Hypertens Res 2021; 44:299–309.