Hypertensive pregnant women had significantly lower global area strain (GAS) values (-28.00 GH, -26.90 PE) versus controls (-32.80), persisting postpartum (p < 0.001).
Does global area strain (GAS) detect differences in left ventricular systolic function between normotensive and hypertensive pregnant women?
Hypertensive pregnant women have significantly worse left ventricular systolic function assessed by global area strain compared to normotensive pregnant women, which persists two months postpartum.
Abstract Background/Introduction Because of the remodeling of the maternal left ventricle in gestational hypertension (GH) and preeclampsia (PE) volume-dependent parameter such as ejection fraction is not so precise for the assessment of systolic function. It is considered that the speckle tracking is more adequate for the assessment of subclinical damage of the systolic function of the left ventricle, as well as that the three-dimensional (3D) assessment of the systolic function and volumes of the left ventricle is superior compared to the two-dimensional one. Global area strain (GAS) is a relatively new method of 3D echocardiographic technique, which simultaneously evaluates both the longitudinal and circumferential function of the left ventricle, and can represent a tool for a more accurate evaluation of the systolic function of the left ventricle in pregnant women, without geometric and volume assumption. Purpose We were interested whether there is a difference in the assessment of the left ventricular systolic function by GAS between normotensive and hypertensive (gestational hypertension and preeclampsia) pregnant women in the third trimester of pregnancy, as well as in the postpartum period. Methods A total of 121 pregnant women were included in this prospective study (26 normotensive controls, 49 with GH and 46 with PE). They underwent complete clinical and echocardiographic exam, as well as 24-hour ambulatory blood pressure monitoring in the third trimester of pregnancy and two months after delivery. In the postpartum period, all women became normotensive, if not, they were excluded from the study. Results There was a significant difference in GAS values between groups. Controls: -32.80 (-32.30;-33.40); GH: -28.00 (-27.60;-29.20); PE: -26.90 (-26.00;-27.80), (p 0.001). Two months after delivery there was an improvement in the GAS values, but a statistically significant difference remained between the groups, i.e. women who had GH -32.80 (-32.10;-34.30) and PE -32.75 (-32.10;-34.10) during pregnancy still had significantly lower absolute GAS values compared to those who were normotensive -34.10 (-33.70;-35.00), (p 0.001), while there was no significant difference in GAS values after delivery between those who had GH and those who had PE (p = 0.103). Conclusion Hypertensive pregnant women have significantly worse left ventricular systolic function assessed by GAS compared to normotensive pregnant women. Worse GAS values after delivery may indicate that they have higher cardiovascular risk in the future. Therefore, they should correct lifestyle habits and risk factors for cardiovascular disease.
Ilic et al. (2025) studied this question. Hypertensive pregnant women had significantly lower global area strain (GAS) values (-28.00 GH, -26.90 PE) versus controls (-32.80), persisting postpartum (p < 0.001).