38 Cardiac structure and function six months after normal and hypertensive pregnancies – The P4 study: Long term consequences for mother and child

Introduction Hypertensive disorders of pregnancy (HDP) are associated with increased post-partum cardiovascular risk in comparison to normal pregnancy (NP). Changes in cardiac structure and function following an HDP have been described previously but whether such changes are useful in identifying women at increased cardiovascular risk is not known. Echocardiography is a non-invasive tool used in the detection of early systolic and diastolic dysfunction. Objectives To assess cardiac structure and function by echocardiography in women, 6months after NP or pregnancy complicated by either gestational HT or pre-eclampsia (HDP group). Methods The study enrolled a prospective cohort of women recruited to the ongoing P4 (Postpartum Physiology, Psychology, and Paediatric follow up) study at St George Hospital, Kogarah, Sydney. Echocardiography was performed six months after either NP or HDP. Trained cardiac sonographers were blinded to whether women had a NP or an HDP. All studies were performed on the Phillips iE33 and Epic machines at St George Hospital. Women with known chronic hypertension were excluded. Statistical analysis was completed using independent t -tests. Results Forty eight women have been recruited to date ( n =22 NP, n =26 HDP). The HDP group showed subtle evidence of structural change with trend to increased 2D ventricular septal wall thickness (8.9±1.3 v 3±0.9mm, HDP v NP, p =0.08), increased posterior wall thickness (8.8±1.1 v 7.8±0.7mm, HDP v NP, p p p 1.0). Systolic function was similar between groups, measured by ejection fraction (63±4 v 62±15, HDP v NP, p =n.s.) and global longitudinal strain (−19.3±1.6 v −19.8±5.3, HDP v NP, p =n.s.). All of the echocardiographic parameters reported above were within normal ranges. Conclusions Six months post-partum, women with prior HDP had early structural and functional changes compared to NP. There were no features of systolic dysfunction or strain but there were subtle features of increased ventricular mass and diastolic dysfunction. In another abstract, we have reported that the same HDP group have higher 24h brachial and central BP. The cardiac changes are within (current) normal ranges and unlikely to be useful alone in predicting increased CV risk, but may be useful in future if included in CV risk algorithms.