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Poster Session 1

Category: Hypertension

Poster Session 1

(227) Diagnostic Accuracy of Point-of-Care Echocardiography for Detecting Cardiac Remodeling in Pregnant Patients with Chronic Hypertension

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Jameson A. Mitchell, MD (she/her/hers)

OB/GYN Resident
Cleveland Clinic Foundation
Cleveland, Ohio, United States

Coauthor(s)

EC

Edward Chien, MD

Staff Physician, Maternal-Fetal-Medicine
Cleveland Clinic Foundation
Cleveland Clinic Foundation, Ohio, United States
MF

Margaret Fuchs, MD

Staff Physician, Cardiology
Cleveland Clinic Foundation
Cleveland, Ohio, United States
NO

Nancy Obuchowski, PhD

Vice Chair, Quantitative Health Sciences
Cleveland Clinic Foundation
Cleveland, Ohio, United States
KH

Karlee Hoffman, DO

Staff Physician, Cardiology
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Justin R. Lappen, MD

Staff Physician, Maternal-Fetal-Medicine
Cleveland Clinic Foundation
Cleveland, Ohio, United States

Objective:
Pathologic cardiac remodeling is common in pregnancies complicated by stage 2 chronic hypertension (cHTN) and is associated with adverse outcomes. This study evaluated the diagnostic accuracy of point-of-care echocardiography (POC-E) compared to transthoracic echocardiography (TTE) in detecting left ventricular (LV) remodeling in pregnant patients with cHTN.

Study Design:
We conducted an IRB-approved prospective cohort study of pregnant patients aged 18-45 with stage 2 cHTN. Exclusion criteria included multiple gestation, abnormal aneuploidy screening, major fetal anomalies, congenital or acquired heart disease, and connective tissue disorders. All participants underwent POC-E at enrollment, followed by TTE within 4 weeks. A parasternal long-axis image was obtained at end-diastole to measure LVID, IVS, and PWT to calculate left ventricular mass index (LVMI) and Relative Wall thickness (RWT) (Figure 1). Remodeling was defined as RWT > 0.42 or LVMI > 0.95. The primary outcome was the diagnostic accuracy of POC-E for detecting cardiac remodeling by receiver operating characteristic analysis compared to TTE. Secondary outcomes included associations between remodeling and adverse maternal or perinatal outcomes. Assuming a remodeling prevalence of 51%, we calculated that 68 participants would provide 80% power (α=0.05) to detect an AUC >0.7.

Results:
190 patients were screened and 83 were enrolled. Of these, 61 (73%) completed both POC-E and TTE and were included in the primary analysis. The median interval between the POC-E and TTE was 4 weeks (IQR 3, 7). The estimated AUC of POC-E for detecting remodeling was 0.56 (95% CI: 0.41–0.70) (Figure 2). Sensitivity and specificity were 51.7% and 59.4%, respectively. No significant associations were found between TTE-assessed LV remodeling and adverse maternal or perinatal outcomes.

Conclusion:
In pregnant patients with cHTN, POC-E demonstrated limited accuracy in diagnosing LV remodeling. While POC-E can be utilized for qualitative cardiac evaluation, further studies are needed to assess if quantitative applications can be validated in an obstetric population.