Cardiac Phenotypes of Pregnant Women with Hypertensive Disorders in Different Ethnic Groups

Abstract

The objective of this study was to conduct a comparative analysis of the features of LV myocardial remodeling in pregnant women with chronic arterial hypertension (CAH) and preeclampsia (PE) on the background of CAH. Methods and Results: The study cohort included pregnant women (n=547) with hypertensive disorders. All women were divided into two groups: Group 1 included 376 Caucasian patients living in the Republic of Dagestan; Group 2 included 171 patients living in the Republic of Sakha (Yakutia) (indigenous residents [Yakuts and Evenks). Later on, all patients were divided into the following subgroups: Sub1A (n=134), and Sub2A (n=69) – pregnant women with CAH; Sub1B (n=242) and Sub2B (n=102) – pregnant women with PE on the background of CAH. The diagnosis of pregnant women with CAH was made on the basis of existing national and foreign recommendations that an increase in SBP ≥140 mmHg and/or DBP ≥90 mmHg indicates CAH. Different patterns of left ventricular (LV) geometry were defined based on left ventricular mass index (LVMI) and relative wall thickness (RWT), as recommended by the American Society of Echocardiography. The observed/predicted LVM ratio was calculated as 100×(oLVM/pLVM). Participants with an oLVM/pLVM ratio of >128% were categorized as having “inappropriate” LVM (iLVM). iLVM was found in Subgroups 1B and 2B in the third trimester. The frequency of LV remodeling in pregnant women of Subgroups 1 A and 2A in the second and third trimesters did not differ significantly. In Subgroup 1B, the frequency of concentric left ventricular hypertrophy (cLVH) was higher in the third trimester (42.6%) than in the second trimester (26.9%) (P=0.000). Moreover, in the third trimester, the frequency of cLVH was significantly higher in Subgroup 1B than in Subgroup 2B (42.6% and 29.4%, respectively, P=0.022). At the same time, in the third trimester, the frequency of left ventricular concentric remodeling (LVCR) was significantly higher in Subgroup 2B than in Subgroup 1B (56.9% and 44.2%, respectively, P=0.032). In the second trimester in Subgroup 1B, the frequency of LVCR was higher than in Subgroup 1A: 50% and 38.1%, respectively, P=0.026). By the third trimester, the severity of LV remodeling has increased significantly in Subgroup 1B. Thus, in Subgroup 1B, the frequency of c LVH reached 42.6% compared to 31.3% in Subgroup 1A (P=0.03). In Subgroup 2B, in the third trimester, the frequency of LVCR was slightly higher than in Subgroup 2A (56.9% and 43.5%. respectively, P=0.08). Conclusion: Living conditions predetermine the prevalence of iLVM and LVCR in pregnant northerners with CAH. A more common type of LV remodeling in pregnant women with CAH in conditions of high-altitude hypoxia is also LVCR, which transforms into cLVH by the third trimester in pregnant women with PE on the background of CAH. The study of the type of LV geometry and the appropriateness of LVM allows us to clarify the degree of LV damage in hypertension-related pregnancy. iLVM in pregnant women with CAH appears to be a predictor of the development of PE. The revealed changes in the LV structure—LVCR and cLVH—are more significant in PE on the background of CAH.