Left ventricular dysfunction following pregnancy with hypertensive disorders - 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), including gestational hypertension and preeclampsia (PE), are associated with an increased long-term risk of maternal cardiovascular disease. However, whether subclinical cardiac changes with echocardiographic systolic dysfunction are already present in the postpartum period remains unclear.
Purpose
We aimed to conduct a systematic review and meta-analysis evaluating echocardiographic systolic dysfunction in the postpartum period among women with HDP.
Methods
A systematic search was conducted in PubMed, Embase, and Cochrane database for studies evaluating left ventricular systolic dysfunction in postpartum period in women with HDP. Global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF) were extracted for women with HDP and PE. 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. Statistical analysis was conducted using RevMan.
Results
Thirteen observational studies were included, with 1.589 patients. Postpartum GLS was significantly impaired in women with previous HDP compared with controls (MD 1.23 [CI 95%: 0.60 to 1.85]; p=0.0001; I² 65% - Figure 1A) and also in women with PE (MD 2.39 [CI 95%: 1.48 to 3.29]; p<0.00001; I² 29% - Figure 1B). LVEF did not differ significantly between women with previous HDP and controls (MD -0.35 [CI 95%: -1.09 to 0.39]; p=0.36; I² 5% - Figure 2A), but was significantly reduced in women with previous PE compared with controls (MD -2.76 [CI 95%: -4.61 to -0.90]; p=0.004; I² 46% - Figure 2B).
Conclusions
Women with a history of hypertensive disorders of pregnancy exhibit impaired postpartum left ventricular systolic function, predominantly detected by reduced GLS. These findings indicate the presence of early, subclinical systolic dysfunction after HDP, particularly following PE, supporting the role of echocardiographic strain imaging for early cardiovascular risk stratification in this population.Figure 1Figure 2