Abstract
Introduction
Some authors have confirmed changes in function of the right hearth in different conditions with endothelial dissfunction, such as systemic hypertension and metabolic syndrome. During gestational hypertension (GH), endothelial disfunction is one of the main pathogenic causes of vasoconstriction and placental insuficiety and following intrauterine growth restriction. Few authors evaluated function of the right ventricle during gestational hypertension, but to our knoledge, there are no studies about right atrial function during gestational hypertension.
Purpose
We hypothesized that there are changes in right atrial function durig gestational hypertension, and wondered if they are reversible.
Methods
Study included 45 pregnant women. 25 with GH (defined as blood pressure ≥140/90mmHg that appeared after 20th week of gestation and disappeared within six weeks postpartum) and 20 normotensivewomen,as control. Function of right atrium and right ventricle was evaluated according to the last guidelines for chamber quantification. Additionally, right atrial function was assessed with p-p cycle speckle tracking. Echo was performed in the third trimester of pregnancy and 6 weeks after delivery.
Results
Parameters showed impairment of RV diastolic function. Women with gestational hypertension had E/e" over the normal value and higher than healthy pregnants, althow difference was not significant. ( 6.46 +- 4.7 vs 5.16 +- 1.9, p =0.66). TDI derived E" from lateral tricuspid annulus was significantly lower in hypertensive group (0.11 +- 0.03 vs 0.14 +- 0.03 p= 0.023). Atv – right ventricle late filling velocity was significantly higher in patients with GH (0.61 +- 0.1 vs 0.51+-0.12, p= 0.08) .
All pregnant women had normal values of RA dimensions, RA endsystolic area, RA endsystolic volume (RAVs). RAVs was significantly larger in GH group (34.64 +-12 vs 27.9+- 9.89, p= 0.041) comparing to the controls, but when we indexed it to the BSA, difference disappeared. Peak longitudinal strain was signfificantly higher in hypertensive group (33.49+- 2.48 vs 28.05+- 4.52, p= 0.001). After Pearson correlation of peak longitudinal strain with parameters of right ventricle diastolic function was done, there was possitive correlation between peak longitudinal strain and Etv (right ventricle early filling velocity) in hypertensive group (r 0.646, p 0.017). Also RAVs positively correlated with LAVsI (r= 0.577, p= 0.019), and RAVsI positively correlated with LAVsI (r= 0.690, p = 0.019).
After delivery all changes disappeared.
Conclusion
Our study indicates that right atrium accommodates to the hemodynamic and functional changes during gestational hypertension. It changes because of modified right ventricle diastolic function and probably in the same mode as left atrium. RA peak longitudinal strain is high, so function of the right atrium is preserved, and we assume that short time of mentioned changes during pregnancy, is the reason why.
Atrial function after treatment of atrial septal defects in children under 5 years
