(178) Cardiac Diastolic Dysfunction Predates Hypertensive Disorders of Pregnancy

Objective:
Hypertensive disorders of pregnancy (HDP), including preeclampsia are associated with long-term cardiovascular risk. Prior studies suggest that left ventricular (LV) diastolic function may be impaired in affected individuals. However, it is unknown whether such cardiac changes are detectable before clinical onset of HDP. We aimed to determine whether echocardiographic markers of impaired diastolic function precede a diagnosis of HDP.

Study Design:
We conducted a retrospective case-control study of pregnant individuals who underwent transthoracic echocardiography. Participants were categorized into no-HDP (n=35) and hypertensive disorders of pregnancy (n=25). Echocardiograms were obtained at an average of 34.7 days (range 4-113 days) prior to HDP diagnosis for other comorbidities. Diastolic function was assessed using mitral inflow velocities and tissue Doppler imaging of the septal and lateral mitral annulus. Multinomial logistic regression was performed to assess associations between echocardiographic parameters, adjusting for relevant clinical covariates such as age, body mass index, parity, and chronic hypertension.

Results:
Despite patients having echocardiographic values in the normal range, the HDP group showed early signs of trend towards diastolic dysfunction. The lateral E’ was significantly lower in the HDP group (12.6 ± 3.0 cm/s) compared to the no-HDP group (15.3 ± 7.2 cm/s, p=0.05). Additionally, Grade I diastolic dysfunction was more frequent in HDP cases (48% vs. 23%, p=0.04). Other diastolic indices, such as septal E’ and E/A ratio, showed a non-significant trend towards impairment. Systolic function as evidenced by left ventricular ejection fraction remained preserved in both groups.

Conclusion:
Subclinical diastolic dysfunction, as evidenced by reduced lateral E’ velocities and higher frequency of Grade I diastolic dysfunction is present prior to the onset of HDP. These subtle changes occur weeks before the clinical diagnoses suggesting that cardiac remodeling predates preeclampsia.