Alterações cardíacas estruturais e funcionais em grávidas com hipertensão gestacional e grávidas com hipertensão crônica: estudo ecocardiográfico comparativo
Carregando...
Arquivos
Data
2023-12-06
Autores
Albuquerque, Ana Maria Portela de
Orientadores
Mancuso, Frederico José Neves
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A hipertensão arterial é uma causa importante de óbito materno na gestação. O presente estudo teve como objetivo avaliar e comparar as modificações estruturais e funcionais das câmaras cardíacas em grávidas com hipertensão gestacional (HG) e grávidas com hipertensão crônica (HC) no final da gestação e no puerpério. Método: Foram realizados estudos ecocardiográficos no terceiro trimestre da gravidez e no puerpério em 10 grávidas com HG, 10 grávidas com HC e 10 grávidas saudáveis (grupo controle; GC). A análise de variância, com pós-teste de Bonferroni foi utilizada para comparações entre os grupos. Resultados: No final da gravidez, o volume do átrio esquerdo indexado (VAEi), o diâmetro diastólico do ventrículo esquerdo (DDVE) e o volume diastólico final do ventrículo esquerdo (VDFVE) foram significativamente maiores nas gestantes com HC do que no GC (p=0,048; p=0,024; p=0,034, respectivamente). O índice de massa do ventrículo esquerdo (IMVE), o tempo de relaxamento isovolumétrico (TRIV) e o diâmetro sistólico do ventrículo esquerdo (DSVE) foram significativamente maiores na HG e na HC do que no GC (p: 0,008; p<0,001; p: 0,003; respectivamente). A fração de ejeção do VE foi significativamente menor nos grupos HG e HC do que no GC (p=0,017). No puerpério, o VAEi, o DDVE, o VDFVE reduziram significativamente na HC (p<0,001; p=0,008; p=0,014; respectivamente). No puerpério, o diâmetro sistólico do ventrículo esquerdo (DSVE), o IMVE e o tempo de desaceleração da onda E (TDE) foram maiores na HC em comparação ao GC (p=0,032; p=0,022; p=0,039; respectivamente). O TRIV se manteve elevado na HG e na HC em comparação ao GC (p=0,002). No puerpério, a onda e’ lateral do ventrículo esquerdo foi menor no grupo HC do que no GC (p=0,038). O diâmetro do ventrículo direito diminuiu significativamente entre a gravidez e o puerpério nos grupos HG, HC e GC (p=0,005; p=0,005; p=0,009; respectivamente). Conclusão: Gestantes com hipertensão arterial apresentam dilatação do ventrículo esquerdo e maior IMVE. As gestantes hipertensas também apresentam menor fração de ejeção e maior tempo de relaxamento isovolumétrico do que as gestantes saudáveis, indicando alterações estruturais e funcionais durante a gravidez em grávidas hipertensas com hipertensão gestacional e hipertensão crônica.
Background: Hypertension is an important cause of maternal mortality during pregnancy. The present study aimed to evaluate and compare the structural and functional changes of the cardiac chambers in pregnant women with gestational hypertension (GH) and pregnant women with chronic hypertension (CH) at the end of pregnancy and in the puerperium. Methods: Echocardiographic studies were performed in the 3rd trimester of pregnancy and in the puerperium in 10 pregnant women with GH, 10 pregnant women with CH and 10 healthy pregnant women (control group; CG). Analysis of variance with Bonferroni post-test was used for comparison between groups. Results: At the end of pregnancy, left atrial volume (LAV), left ventricular diastolic diameter (LVDD) and left ventricular end-diastolic volume (LVEDV) were significantly higher in pregnant women with CH than in CG (p = 0.048; p = 0.024; p = 0.034; respectively). Left ventricular mass index (LVMI), isovolumetric relaxation time (IVRT) and left ventricular systolic diameter (LVSD) were significantly higher in GH and CH than in GC (p: 0.008; p < 0.001; p: 0.003; respectively). The LV ejection fraction was significantly lower in the CH and HG groups than in the CG (p = 0.02). In the puerperium, LAV, LVDD and left ventricular end-diastolic volume (LVEDV) were significantly reduced in CH (p < 0.001; p = 0.008; p = 0.014; respectively). In the puerperium, left ventricular systolic diameter (LVSD), LVMI and E wave deceleration time (EDT) were higher in CH compared to CG (p = 0.032; p = 0.022; p = 0.039; respectively). IVRT remained elevated in CH and GH compared to CG (p=0.002). In the puerperium, the lateral e' wave of the left ventricle was lower in the CH group than in the CG (p=0.038). Ventricular diameter decreased significantly between pregnancy and puerperium in the HG, CH and GC groups (p = 0.005; p = 0.005; p = 0.009; respectively). Conclusion: Pregnant women with hypertension have changes in left ventricular geometry, with left ventricular dilatation. Hypertensive pregnant women also have a lower ejection fraction and longer isovolumetric relaxation time than healthy pregnant women, indicating structural and functional changes during pregnancy in hypertensive pregnant women with gestational hypertension and chronic hypertension.
Background: Hypertension is an important cause of maternal mortality during pregnancy. The present study aimed to evaluate and compare the structural and functional changes of the cardiac chambers in pregnant women with gestational hypertension (GH) and pregnant women with chronic hypertension (CH) at the end of pregnancy and in the puerperium. Methods: Echocardiographic studies were performed in the 3rd trimester of pregnancy and in the puerperium in 10 pregnant women with GH, 10 pregnant women with CH and 10 healthy pregnant women (control group; CG). Analysis of variance with Bonferroni post-test was used for comparison between groups. Results: At the end of pregnancy, left atrial volume (LAV), left ventricular diastolic diameter (LVDD) and left ventricular end-diastolic volume (LVEDV) were significantly higher in pregnant women with CH than in CG (p = 0.048; p = 0.024; p = 0.034; respectively). Left ventricular mass index (LVMI), isovolumetric relaxation time (IVRT) and left ventricular systolic diameter (LVSD) were significantly higher in GH and CH than in GC (p: 0.008; p < 0.001; p: 0.003; respectively). The LV ejection fraction was significantly lower in the CH and HG groups than in the CG (p = 0.02). In the puerperium, LAV, LVDD and left ventricular end-diastolic volume (LVEDV) were significantly reduced in CH (p < 0.001; p = 0.008; p = 0.014; respectively). In the puerperium, left ventricular systolic diameter (LVSD), LVMI and E wave deceleration time (EDT) were higher in CH compared to CG (p = 0.032; p = 0.022; p = 0.039; respectively). IVRT remained elevated in CH and GH compared to CG (p=0.002). In the puerperium, the lateral e' wave of the left ventricle was lower in the CH group than in the CG (p=0.038). Ventricular diameter decreased significantly between pregnancy and puerperium in the HG, CH and GC groups (p = 0.005; p = 0.005; p = 0.009; respectively). Conclusion: Pregnant women with hypertension have changes in left ventricular geometry, with left ventricular dilatation. Hypertensive pregnant women also have a lower ejection fraction and longer isovolumetric relaxation time than healthy pregnant women, indicating structural and functional changes during pregnancy in hypertensive pregnant women with gestational hypertension and chronic hypertension.
Descrição
Citação
ALBUQUERQUE, Ana Maria Portela de. Alterações cardíacas estruturais e funcionais em grávidas com hipertensão gestacional e grávidas com hipertensão crônica: estudo ecocardiográfico comparativo. 2024. 57 f. Dissertação (Mestrado em Cardiologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.