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Am J Perinatol 2023; 40(11): 1163-1170
DOI: 10.1055/a-2096-5114
SMFM Fellowship Series Article

Concentric Cardiac Remodeling and Hypertrophy in Pregnant Individuals with Chronic Hypertension

Elizabeth A. Seagraves
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Dana I. Baraki
2   Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio
,
Thomas J. Donaldson
3   Department of Obstetrics and Gynecology, Temple University, Philadelphia, Pennsylvania
,
Carole Barake
4   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
John E. Brush
5   Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
,
Alfred Z. Abuhamad
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Tetsuya Kawakita
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to evaluate rates of superimposed preeclampsia in pregnant individuals with echocardiography-diagnosed cardiac geometric changes in the setting of chronic hypertension.

Study Design This was a retrospective study of pregnant individuals with chronic hypertension who delivered singleton pregnancies at 20 weeks' gestation or greater at a tertiary care center. Analyses were limited to individuals who had an echocardiogram during any trimester. Cardiac changes were categorized as normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy according to the American Society of Echocardiography guidelines. Our primary outcome was early-onset superimposed preeclampsia defined as delivery at less than 34 weeks' gestation. Other secondary outcomes were also examined. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for prespecified covariates.

Results Of the 168 individuals who delivered from 2010 to 2020, 57 (33.9%) had normal morphology, 54 (32.1%) had concentric remodeling, 9 (5.4%) had eccentric hypertrophy, and 48 (28.6%) had concentric hypertrophy. Non-Hispanic black individuals presented over 76% of the cohort. Rates of the primary outcome in individuals with normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were 15.8, 37.0, 22.2, and 41.7%, respectively (p = 0.01). Compared with individuals with normal morphology, individuals with concentric remodeling were more likely to have the primary outcome (aOR: 3.28; 95% CI: 1.28–8.39), fetal growth restriction (crude OR: 2.98; 95% CI: 1.05–8.43), and iatrogenic preterm delivery <34 weeks' gestation (aOR: 2.72; 95% CI: 1.15–6.40). Compared with individuals with normal morphology, individuals with concentric hypertrophy were more likely to have the primary outcome (aOR: 4.16; 95% CI: 1.57–10.97), superimposed preeclampsia with severe features at any gestational age (aOR: 4.75; 95% CI: 1.94–11.62), iatrogenic preterm delivery <34 weeks' gestation (aOR: 3.60; 95% CI: 1.47–8.81), and neonatal intensive care unit admission (aOR: 4.82; 95% CI: 1.90–12.21).

Conclusion Concentric remodeling and concentric hypertrophy were associated with increased odds of early-onset superimposed preeclampsia.

Key Points

  • Concentric remodeling and concentric hypertrophy were associated with an increased risk of superimposed preeclampsia.

  • Concentric hypertrophy was associated with an increased risk of delivery at less than 34 weeks.

  • Two-thirds of the individuals in our study had concentric hypertrophy and concentric remodeling.

Keywords

cardiac - chronic hypertension - echocardiography - pregnancy

Note

This study was presented as a poster the SMFM 42nd Annual Pregnancy Meeting (January 31–February 5, 2022).




Publication History

Received: 14 October 2022

Accepted: 19 May 2023

Accepted Manuscript online:
22 May 2023

Article published online:
19 June 2023

© 2023. Thieme. All rights reserved.

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