04 February 2019 by Mamotabo Rossy Matshela

The prognostic implications pulmonary hypertension in pregnancy: Echocardiography based study

Background:

The prevalence of pulmonary hypertension (PH) in pregnancy has previously been reported to vary, in some studies an estimated prevalence of less than 5% had been reported in smaller studies; however, its prognostic implications in larger studies is still warranted. The aim of this study was to evaluate the prognostic implications of PH in pregnancy; strictly in a resource constrained centre. We also evaluated the association between left ventricular ejection fraction (LVEF) with mPASP, and symptoms and contributing factors of PH in our patients.

Methods:

A total of 103 pregnant patients (mean age 22 years) with preserved LV function, LVEF >55% and PH were studied. Two-dimensional transthoracic echocardiographic images were evaluated, prospectively and introspectively, between 1 January 2009 and 31 August 2018. Patients were divided into 3 groups or tertiles based on the severity of PH, and this was a matched study.

Results:

The prevalence of PH was less than 3% of the pregnant women evaluated in our clinic during the study period. There was a strong relationship between the severity of PH and patient’s symptoms, length of hospital stays, and recurrent hospital visit post-dismissal, p<0.001. There was a strong inverse relationship between the severity PH and RV TAPSE, -0.80, p=0.001 and between LA size and severity of PH; Ɣ2 0.75, p<0.001. The following factors were associated with the development of PH: subclinical LV dysfunction, older age at conception and prior use of contraceptives, presence of hypertension and diabetic (p<0.0001).

Conclusion:

The prevalence of PH in pregnancy is on arise, higher than previously reported. PH was highly variable in patients with subclinical LV dysfunction and correlated with the severity of symptomatology, and traditional risk factors for cardiac disease. However, more work need be done regarding patient’s follow-up and impact of PH on their new-borns.

Key Contributors

Mamotabo Matshela : University of KwaZulu-Natal, Durban, South Africa


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