Fetal Myocardial Function in Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis
A M C X Carvalho, V C Brito, J Peres de Oliveira, B R Silva, I R Santander, C Fischer BaccaAbstract
Introduction
Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia (PE) and gestational hypertension (GH), create an adverse intrauterine environment that can affect fetal growth and cardiac fetal dysfunction. However, the impact of HDF in cardiac fetal function is not well understood.
Purpose
We aimed to conduct a systematic review and meta-analysis evaluating cardiac fetal dysfunction in pregnant women with HDP.
Methods
A systematic search was conducted in PubMed, Embase, and Cochrane database for studies evaluating cardiac fetal function in patients with HDP. Echocardiography parameters were collected, and the outcomes were: 1) Left ventricular (LV) function: LV ejection fraction (LVEF) and LV global longitudinal strain (LVGLS); and 2) Right ventricular (RV) function: RV global longitudinal strain (RVGLS). Statistical analysis was performed using RStudio. Pooled mean differences (MD) were estimated using a random-effects model, with a significance level of 0.05. Confidence interval (CI) of 95% was adopted and heterogeneity was accessed using I².
Results
Six observational studies were included, with 7.999 patients. LV function was significantly reduced in fetuses of pregnant women with HDP. LVGLS in fetuses of pregnant women with HDP were reduced (MD 1.17 [CI 95%: 0.23 to 2.11]; p=0.015; I² 0% - Figure 1A) and also even more impaired in pregnant women with PE (MD 1.31 [CI 95%: 0.56 to 2.06]; p<0.001; I² 16.3%- Figure 2A), when compared with healthy pregnant women. Compared with the control group, fetal LVEF was discreetly reduced in HDP (MD -0.02 [CI 95%: -0.04 to 0.00]; p=0.015; I² 32.8% - Figure 1C), but not in PE (MD -0.02 [CI 95%: -0.05 to 0.01]; p=0.20; I² 40.4% - Figure 2C). RV function did not show a significant reduction in pregnant women with HDP (MD -2.02 [CI 95%: -0.10 to 4.13]; p=0.06; I² 89.3% - Figure 1B) nor in PE (MD 0.61 [CI 95%: -1.42 to 2.63]; p=0.55; I² 95.5% - Figure 2B).
Conclusion
Fetuses of pregnant women with HDP, and specially PE, have reduction in LV myocardial function, with a decline in LVGLS.Figure 1Figure 2