Cardiac Morphology and Flow Dynamics in Children Born to Hypertensive Pregnancies
Prenali Dwisthi Sattwika, Katie Suriano, João Filipe Fernandes, Tamara den Harink, Christina Yi Ling Aye, Yvonne Kenworthy, Annabelle McCourt, Betty Raman, Zakariye Ashkir, Aaron Timothy Hess, Joana Leal Pelado, Federica Viola, Tino Ebbers, Carl-Johan Carlhäll, Petter Dyverfeldt, Adelaide de Vecchi, Winok Lapidaire, Paul Leeson, Pablo Lamata, Adam James LewandowskiAbstract
Aims
Hypertensive pregnancies affect up to 10% of pregnancies globally and are linked to greater cardiovascular risk in offspring. Subclinical cardiac changes have been reported across developmental stages. This study aimed to assess whether children born to hypertensive pregnancies exhibit altered left ventricular (LV) morphology and cardiac flow characteristics.
Methods
In this cross-sectional study, cardiovascular magnetic resonance (CMR) was performed on a 3.0-Tesla Siemens Prisma scanner in children aged 6–9 years: 44 offspring of hypertensive pregnancies (50% female) and 56 controls from normotensive pregnancies (37.5% female). Free-breathing real-time cine images were acquired to assess structure and function and to create a computational LV shape atlas. Four-dimensional (4D) Flow CMR was acquired to quantify LV flow component volumes and kinetic energy (KE), enabling assessment of intraventricular flow organisation and energetics.
Results
Children born to hypertensive and normotensive pregnancies were matched in age (7.49 ± 0.73 and 7.41 ± 1.12 years), but those from hypertensive pregnancies had significantly shorter gestations (median 37.3 weeks [IQR 35.6–39.0] vs. 39.0 weeks [37.7–40.8], P = 0.002). Conventional cardiac measures did not differ between groups. Exploratory shape analysis identified subtle group-level LV differences, including relative prominence of the basal anterior wall, and a more convex LV outflow tract (P < 0.01; AUC=0.654). LV retained inflow end-diastolic KE was lower in exposed offspring (3.35 [3.03–4.80] vs 5.70 [4.35–6.80] μJ/mL; P < 0.001).
Conclusion
Children born to hypertensive pregnancies show subtle group-level differences in LV morphology and diastolic flow energetics. These findings suggest early differences in cardiovascular phenotype, although their long-term clinical significance remains uncertain and requires longitudinal investigation.