Pulmonary hypertension complicating pregnancy: cardiac remodeling and residual concerns
- Resource Type
- Authors
- F. Gary Cunningham; Christina L. Herrera; Rachel C. Schell; Donald D. McIntire
- Source
- The Journal of Maternal-Fetal & Neonatal Medicine. 35:4104-4109
- Subject
- Cardiac Catheterization
medicine.medical_specialty
Hypertension, Pulmonary
Pulmonary Artery
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Pregnancy
medicine.artery
Internal medicine
medicine
Humans
reproductive and urinary physiology
030219 obstetrics & reproductive medicine
Ventricular Remodeling
business.industry
Obstetrics and Gynecology
medicine.disease
Pulmonary hypertension
Echocardiography
Hypertension
Pediatrics, Perinatology and Child Health
Pulmonary artery
Cardiology
Ventricular pressure
Female
business
- Language
- ISSN
- 1476-4954
1476-7058
To assess pulmonary artery pressure and cardiac remodeling in pregnancy in women with pulmonary hypertension and compare these findings with studies done beyond three months postpartum.Pregnant women with pulmonary hypertension from 2006 to 2017 were studied. Pulmonary hypertension was diagnosed when the pulmonary artery pressure exceeded 30 mmHg as estimated by right ventricular systolic pressure (RVSP) on echocardiography or 20 mmHg measured directly by mean pulmonary artery pressure (PAPm) with right-heart catheterization (RHC). Disease severity was assigned using threshold cutoffs. Indices of cardiac remodeling were compared during pregnancy after 20 weeks' gestation and again beyond three months postpartum when available. Pulmonary artery pressures obtained by echocardiography versus right-heart catheterization were also compared.Forty-six pregnancies complicated by pulmonary hypertension in 41 women were identified. The study included 43 pregnancies that resulted in a livebirth. There were 20 women in whom studies were performed after 20 weeks' gestation and again at least 3 months postpartum or later. Pulmonary artery pressures determined during pregnancy versus beyond three months postpartum were not significantly different when measured by echocardiography (RVSP 53.5 ± 20.5 mmHg and 46.7 ± 20.4 mmHg,Pulmonary artery pressures did not appreciably change during pregnancy after 20 weeks' gestation compared with pressures measured again beyond three months postpartum. Women with pulmonary hypertension did not show evidence of remodeling of left ventricular mass or relative wall thickness when measured in pregnancy after 20 weeks' gestation compared with beyond three months postpartum in this limited cohort. These findings suggest that cardiac remodeling in women with pulmonary hypertension is different from that of normally pregnant women and confirms the need for careful long-term follow-up.