Cardio-immunological and echocardiographic study in pregnant women with arterial hypertension

Abstract

Hypertensive disorders of pregnancy are associated with maternal cardiovascular and immunological alterations. Investigation of macrophage–lymphocyte rosettes(MLR) formation may provide additional information on these disorders.

Our purpose was to assess cardiovascular changes and activity of immunocompetent cells in pregnant women(P) with hypertensive disorders and to evaluate their dynamics during treatment.

We observed 90 P aged 18-45y. Arterial hypertension (AH, BP>140/90mmHg) was detected in 24P, among them 4 P had pre-existing hypertension(PEH), 8 - gestational arterial hypertension(GAH), 12 – preeclampsia(PE) without other co-morbidities. All P underwent ecg, echocardiography(TTE), lab tests and estimation of MLR formation in 72-hour blood leukocyte cultures. All patients received treatment according to escardio guideline 2025. Follow-up evaluations were performed after clinical stabilization and delivery.

In heathy donors amount of MLR equals 37,4 ±2.2%, In the physiological pregnant women(ph P) MLR is decreased compared to donors and amounts to 26,1±4,3%. Elevated levels of MLR were observed in P with AH compared to ph P. Previous studies showed that MLR in vitro increases significantly in P with stress predicting premature birth. We divided P into 4 groups(gr): I- phys P, II- P with PEH, III- P with GAH, IV- P with PE. In I gr amount of MLR was in normal range (18 – 29%), while it was moderately increased in II and III gr(30-40%) and significantly increased in III gr (45-60%) indicating impending premature birth. Notable, that 3P with PrE developed peripartum cardiomyopathy(PPCM) after 36 weeks of pregnancy.

According to TTE mild mitral regurgitation(mMR) was observed in 85% of phP, while only 33% of P with AH had mild MR and the rest 67% had moderate MR. Left atrial size was normal in phP, in P with AH it was normal or borderline to increased, in 3 with PE it was increased. These 3P revealed PPCM with diastolic disfunction(DD) -impaired relaxation, decreased ejection fraction(EF) and markedly increased NT-proBNP. In other P with AH or PE, EF was preserved. DD was observed only in 6P with PE (50% of PE) including P with PPCM. Following treatment and delivery, normalization of blood pressure, resolution of volume overload, and markedly reduction of MLR up to normal range were observed.

Hypertensive disorders of pregnancy are associated with increased MLR formation, reflecting activation of immunological processes. The dynamic reduction of MLR levels in parallel with clinical stabilization, normalization of central hemodynamics, suggests its potential role as a marker for disease severity and therapeutic effectiveness in addition to Echo data. Future studies on the multiple aspects of immune–cardiovascular interactions of the development of AH and PE in P will support to the achievement of personalized management strategies in cardio-obstetrics.Echo-38yo-34wks-Preeclampsia