Echocardiographic Structure and Function in Hypertensive Disorders of Pregnancy: A Systematic Review.
BACKGROUND
Echocardiography is commonly used to direct the management of hypertensive disorders in medical patients, but its application in pregnancy is unclear. Our objective was to define the use of echocardiography in pregnancies complicated by gestational hypertension (GH) and preeclampsia.


RESULTS
We performed a systematic review of articles using an electronic search of databases from inception to March 2015, prospectively registered with PROSPERO (CRD42015015700). Eligible studies included pregnant women with GH or preeclampsia, evaluating left ventricular structure and function using echocardiography. The search strategy identified 36 studies, including 745 women with GH and 815 women with preeclampsia. The populations were heterogeneous with respect to clinical characteristics, parity, and risk of bias. Increased vascular resistance and left ventricular mass were the most consistent findings in GH and preeclampsia. Differentiating features from normal pregnancy were left ventricular wall thickness of ≥1.0 cm, exaggerated reduction in E/A, and lateral e' of <14 cm/s. There was disagreement between studies with regard to cardiac output because of the timing of echocardiography, although reduced stroke volume was an indicator of adverse prognosis. Diastolic dysfunction and left ventricular remodeling are most marked in severe and early-onset preeclampsia, but are also markers of preeclampsia before clinical manifestation, and are associated with adverse outcomes.


CONCLUSIONS
Echocardiography is a valuable tool to stratify risk and can guide management and counseling in the preclinical and clinical phases of GH and preeclampsia. Changes in cardiac function and morphology are recognizable at an asymptomatic early stage and correlate with disease severity and adverse outcomes.
From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (J.S.C., G.Y.H.L., D.K.); Department of Maternity and Perinatal Medicine, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom (J.S.C., F.T.); Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom (R.G.); and Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (R.P.S., D.K.).
James S
JS
Castleman
From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (J.S.C., G.Y.H.L., D.K.); Department of Maternity and Perinatal Medicine, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom (J.S.C., F.T.); Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom (R.G.); and Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (R.P.S., D.K.).
Ramesh
R
Ganapathy
From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (J.S.C., G.Y.H.L., D.K.); Department of Maternity and Perinatal Medicine, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom (J.S.C., F.T.); Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom (R.G.); and Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (R.P.S., D.K.).
Fatima
F
Taki
From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (J.S.C., G.Y.H.L., D.K.); Department of Maternity and Perinatal Medicine, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom (J.S.C., F.T.); Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom (R.G.); and Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (R.P.S., D.K.).
Gregory Y H
GY
Lip
From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (J.S.C., G.Y.H.L., D.K.); Department of Maternity and Perinatal Medicine, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom (J.S.C., F.T.); Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom (R.G.); and Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (R.P.S., D.K.).
Richard P
RP
Steeds
From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (J.S.C., G.Y.H.L., D.K.); Department of Maternity and Perinatal Medicine, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom (J.S.C., F.T.); Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom (R.G.); and Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (R.P.S., D.K.). d.kotecha@bham.ac.uk.
Dipak
D
Kotecha
D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
echocardiography; hemodynamics; hypertension; preeclampsia; pregnancy; review, systematic