Медицинский вестник Юга России (Sep 2019)
Peculiarities of left ventricular myocardial remodeling among pregnant women with chronic arterial hypertension complicated by preeclampsia
Abstract
Objective: to evaluate the nature of LV myocardial remodeling among pregnant women with chronic arterial hypertension (CAH), complicated by preeclampsia (PE), and the effect of antihypertensive therapy start on the reversibility of cardiac changes.Materials and Methods: pregnant women with CAH (n = 376): group I - with isolated CAH (n = 172), group II - with the development of PE on its background. Depending on the time of antihypertensive therapy start: in the group with CAH - early (n = 58), delayed (n = 76), in the group with PE development on the CAH background - early (n = 114), delayed (n = 128). Clinical and statistical, echocardiography, tissue myocardial doppler echocardiography (TMDEchoCG).Results: the group of pregnant women with PE development on the CAH background was distinguished by large indicators of LV myocardium mass - by 15.5% in the second trimester of pregnancy, 12.1% - in the third one. The initial manifestations of diastolic dysfunction of the left ventricular (LV DD) were diagnosed according to the results of TMDEchoCG: among 28.9 % of pregnant women in the second trimester, 40.3% - in the third one. The frequency of abnormal LV remodeling on the CAH background was 76.3% in the II trimester, 85.4% in the III one, with an increase in LV hypertrophy of the concentric type by the III trimester from 28.2% to 38.6% .The absence of early antihypertensive therapy caused higher frequency of elevated (“> 128”) values of the disproportionality coefficient (DC): with PE development on the CAH background it increased by 1.3 times (60.9% vs 33.3%), with left ventricular hypertrophy (LVH) according to the concentric type - by 1.5 times in the second trimester (34.4% vs 18.8%) and by 2.5 times (59.4% vs 23.7%) - in the third one. The effectiveness of early CAH correction during pregnancy is proved by the lower occurrence of diastolic dysfunction (DD): in the second trimester 22.8% vs 38.3%, in the third one - 21.1% vs 61.7%.Conclusions: it is proved that the probability of LV myocardium damage development on the CAH background increases with the identification of a disproportionately high LV myocardium mass as a result of BP overload. The study of LV and DF geometry allows to clarify the degree of organ damage (myocardium) and the effectiveness of antihypertensive therapy. It is stated that in the absence of rational CAH correction, morphofunctional changes in the LV cardiac muscle progress with the course of pregnancy, to the greater extent - with PE complication.
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