Comprehensive Assessment of Biventricular and Biatrial Myocardial Strain Parameters at 6 Years Postpartum in a Cohort of Women with Previous Hypertensive Disorders of Pregnancy

Background: During the last decade, only a few echocardiographic studies have evaluated myocardial strain parameters in women with previous hypertensive disorders of preg-nancy (HDP), reporting not univocal results. No previous study provided a comprehen-sive evaluation of all biventricular and biatrial deformation indices in pHDP women. Ac-cordingly, we aimed at investigating the structure and deformation properties of all car-diac chambers in a cohort of pHDP women, at 6 yrs postpartum. Methods: A consecutive cohort of pHDP women compared to a control group of normotensive healthy women, matched by age and body mass index (BMI), was analyzed. Both groups of women un-derwent a conventional transthoracic echocardiography (TTE) implemented with com-plete analysis of biventricular and biatrial myocardial deformation indices by speckle tracking echocardiography (STE) and carotid ultrasonography, at 6 yrs postpartum. The primary outcome was subclinical myocardial dysfunction, defined as left ventricular (LV) global longitudinal strain (GLS) impairment (< 20%), whereas the secondary one was early carotid atherosclerosis, defined as common carotid artery (CCA) intima-media thickness (IMT) ≥0.7 mm. Results: 31 pHDP women (42.3 ± 5.9 yrs) and 30 matched healthy controls without pHDP (40.8 ± 5.0 yrs) were analyzed. Mean follow-up period was 6.1 ± 1.3 yrs post-partum. During follow-up, the great majority of biventricular and biatrial myocardial strain and strain rate parameters were significantly lower in pHDP women than controls, despite normal and similar systolic function on conventional TTE. Overall, 58.1% of pHDP women developed subclinical myocardial dysfunction, whereas CCA-IMT was ≥ 0.7 mm in 67.7% of them. Previous pre-eclampsia (PE) (HR 4.01, 95% CI 1.05-15.3, p = 0.03) was independently associated with the primary outcome. Third trimester BMI (HR 1.21, 95% CI 1.07-1.38, p = 0.003) and PE (HR 6.38, 95% CI 1.50-27.2, p = 0.01) were inde-pendently associated with the secondary outcome. A third trimester BMI >27 Kg/m2 showed the best sensitivity and specificity for predicting the secondary outcome. Conclu-sions: Women with previous history of PE have a significantly increased risk of subclini-cal myocardial dysfunction and early carotid atherosclerosis at 6 yrs postpartum.