Exercise Stress Echocardiography Unmasks Subclinical Cardiovascular Dysfunction in Midlife Women Following Hypertensive Disorders of Pregnancy
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Hypertensive disorders of pregnancy (HDP) are a risk factor for early cardiovascular disease in women, perhaps related to adverse cardiovascular reactivity to physiologic stress.
Objectives
To evaluate the association of HDP subtypes with exercise stress echocardiography parameters.
Methods
This retrospective cohort study linked exercise stress echocardiograms with delivery records. HDP was classified as none, gestational hypertension (GH), and preeclampsia (PEC). We compared features of treadmill exercise stress echocardiography among HDP groups, adjusted for maternal demographic characteristics, time between delivery and stress testing, resting blood pressure (BP), and exercise duration.
Results
Among 885 women with matching delivery and exercise echocardiography records (41.4±7.4 years at exercise exam), 92 (10.4%) experienced GH and 39 (4.4%) experienced PEC. Women with PEC were referred for exercise stress testing 3.1 years earlier following delivery (p<0.001) and had shorter exercise duration (ß=-69.6 seconds [95% CI -115.9, -23.4], p=0.003) than those without HDP. Women with GH had higher peak exercise systolic BP (ß=8.96 mmHg [95% CI 4.89, 13.04], p<0.001), diastolic BP (ß=2.67 mmHg [95% CI 0.24, 5.10], p=0.031), and pulse pressure (ß=8.25 mmHg [95% CI 4.11, 12.39], p<0.001) than those without HDP. Women with GH and PEC were twice as likely to have concentric remodeling and more adverse diastolic parameters on echocardiography than those without HDP (p<0.05).
Conclusions
Exercise stress echocardiography may detect subclinical cardiovascular dysfunction in midlife women following HDP, with adverse findings differing by subtype: GH was associated with higher peak exercise BP and PEC with lower exercise capacity.
