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ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 1  |  Page : 78-83

Assessment of the left ventricular function in hypertensive pregnant women with or without proteinuria: two-dimensional versus four-dimensional echocardiographic study


1 Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
2 Department of Obstetrics and Gynecology, ART Unit, International Islamic Institute, Al-Azhar University, Cairo, Egypt

Correspondence Address:
Shaimaa A Habib
Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, 11827
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_9_20

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Background Assessment of left ventricular (LV) function by speckle tracking echocardiography (STE) can detect subtle changes in LV function in preeclampsia. We aimed to assess LV function using two-dimensional (2D) versus four-dimensional (4D) echocardiography in hypertensive (HTN) pregnant women with or without proteinuria. Patients and methods This study comprised 50 HTN pregnant women with proteinuria as G1 and 50 HTN pregnant women with no proteinuria as G2, who were compared with 50 age-matched healthy pregnant women as G3. All were subjected to abdominal ultrasound and echocardiography. Calculation of cardiac output and total vascular resistance derived from 2D echocardiography was done. Assessment of LV systolic function including 2D and 4D ejection fraction (EF), systolic mitral annular velocity, and global longitudinal strain (GLS) by tissue-Doppler imaging (TDI) and 2D and 4D STE was done. Assessments of LV diastolic function, including mitral early and late diastolic velocities by pulsed-Doppler echocardiography (ME and MA), E/A and E/early diastolic mitral annular velocity (Ea) by TDI, and 2D left atrial volume index (LAVI) was performed. Results Interventricular septal wall thickness in diastole, LV posterior wall thickness in diastole, and LV mass index were significantly increased in G1 compared with G2 and G3. Cardiac output and total vascular resistance were significantly increased in G1 compared with G2. LV GLS by TDI, 2D, or 4D STE was significantly lower in G1 compared with G3 and G2, despite the insignificant difference in LVEF. E/Em and LAVI were significantly increased in G1 compared with G2 and G3. A positive correlation was found between 2D and 4D measures. A positive correlation was found between proteinuria and LV mass index and LAVI, whereas a negative correlation was found between proteinuria and LV GLS (2D/4D) and 4D EF. Conclusion Women with HTN associated with proteinuria had significant LV structural and functional changes. Use of newer echocardiographic modalities can detect early subtle changes in cardiac function in those patients.


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