Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated with a History of Hypertensive Pregnancy

Henry Boardman; Pablo Lamata; Merzaka Lazdam; Ashley Verburg; Timo Siepmann; Ross Upton; Amy Bilderbeck; Rhys Dore; Clare Smedley; Yvonne Kenworthy; Yrsa Sverrisdottir; Christina Y.L. Aye; Wilby Williamson; Odaro Huckstep; Jane M. Francis; Stefan Neubauer; Adam J. Lewandowski; Paul Leeson

doi:10.1161/HYPERTENSIONAHA.119.14530

Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated with a History of Hypertensive Pregnancy

Henry Boardman, Pablo Lamata, Merzaka Lazdam, Ashley Verburg, Timo Siepmann, Ross Upton, Amy Bilderbeck, Rhys Dore, Clare Smedley, Yvonne Kenworthy, Yrsa Sverrisdottir, Christina Y.L. Aye, Wilby Williamson, Odaro Huckstep, Jane M. Francis, Stefan Neubauer, Adam J. Lewandowski, Paul Leeson^*

^*Corresponding author for this work

Biomedical Engineering Department

Research output: Contribution to journal › Article › peer-review

18 Citations (Scopus)

Abstract

Hypertensive pregnancy is associated with increased maternal cardiovascular risk in later life. A range of cardiovascular adaptations after pregnancy have been reported to partly explain this risk. We used multimodality imaging to identify whether, by midlife, any pregnancy-associated phenotypes were still identifiable and to what extent they could be explained by blood pressure. Participants were identified by review of hospital maternity records 5 to 10 years after pregnancy and invited to a single visit for detailed cardiovascular imaging phenotyping. One hundred seventy-three women (age, 42±5 years, 70 after normotensive and 103 after hypertensive pregnancy) underwent magnetic resonance imaging of the heart and aorta, echocardiography, and vascular assessment, including capillaroscopy. Women with a history of hypertensive pregnancy had a distinct cardiac geometry with higher left ventricular mass index (49.9±7.1 versus 46.0±6.5 g/m²; P=0.001) and ejection fraction (65.6±5.4% versus 63.7±4.3%; P=0.03) but lower global longitudinal strain (-18.31±4.46% versus -19.94±3.59%; P=0.02). Left atrial volume index was also increased (40.4±9.2 versus 37.3±7.3 mL/m²; P=0.03) and E:A reduced (1.34±0.35 versus 1.52±0.45; P=0.003). Aortic compliance (0.240±0.053 versus 0.258±0.063; P=0.046) and functional capillary density (105.4±23.0 versus 115.2±20.9 capillaries/mm²; P=0.01) were reduced. Only differences in functional capillary density, left ventricular mass, and atrial volume indices remained after adjustment for blood pressure (P<0.01, P=0.01, and P=0.04, respectively). Differences in cardiac structure and geometry, as well as microvascular rarefaction, are evident in midlife after a hypertensive pregnancy, independent of blood pressure. To what extent these phenotypic patterns contribute to cardiovascular disease progression or provide additional measures to improve risk stratification requires further study.

Original language	English
Pages (from-to)	1542-1550
Number of pages	9
Journal	Hypertension
Volume	75
Issue number	6
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.119.14530
Publication status	Published - 1 Jun 2020

Keywords

blood pressure
echocardiography
hypertension
magnetic resonance imaging
pre-eclampsia
pregnancy
women

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1161/HYPERTENSIONAHA.119.14530

Cite this

Boardman, H., Lamata, P., Lazdam, M., Verburg, A., Siepmann, T., Upton, R., Bilderbeck, A., Dore, R., Smedley, C., Kenworthy, Y., Sverrisdottir, Y., Aye, C. Y. L., Williamson, W., Huckstep, O., Francis, J. M., Neubauer, S., Lewandowski, A. J., & Leeson, P. (2020). Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated with a History of Hypertensive Pregnancy. Hypertension, 75(6), 1542-1550. https://doi.org/10.1161/HYPERTENSIONAHA.119.14530

@article{065e131d662d434ea5f4698a3e5c05ad,

title = "Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated with a History of Hypertensive Pregnancy",

abstract = "Hypertensive pregnancy is associated with increased maternal cardiovascular risk in later life. A range of cardiovascular adaptations after pregnancy have been reported to partly explain this risk. We used multimodality imaging to identify whether, by midlife, any pregnancy-associated phenotypes were still identifiable and to what extent they could be explained by blood pressure. Participants were identified by review of hospital maternity records 5 to 10 years after pregnancy and invited to a single visit for detailed cardiovascular imaging phenotyping. One hundred seventy-three women (age, 42±5 years, 70 after normotensive and 103 after hypertensive pregnancy) underwent magnetic resonance imaging of the heart and aorta, echocardiography, and vascular assessment, including capillaroscopy. Women with a history of hypertensive pregnancy had a distinct cardiac geometry with higher left ventricular mass index (49.9±7.1 versus 46.0±6.5 g/m2; P=0.001) and ejection fraction (65.6±5.4% versus 63.7±4.3%; P=0.03) but lower global longitudinal strain (-18.31±4.46% versus -19.94±3.59%; P=0.02). Left atrial volume index was also increased (40.4±9.2 versus 37.3±7.3 mL/m2; P=0.03) and E:A reduced (1.34±0.35 versus 1.52±0.45; P=0.003). Aortic compliance (0.240±0.053 versus 0.258±0.063; P=0.046) and functional capillary density (105.4±23.0 versus 115.2±20.9 capillaries/mm2; P=0.01) were reduced. Only differences in functional capillary density, left ventricular mass, and atrial volume indices remained after adjustment for blood pressure (P<0.01, P=0.01, and P=0.04, respectively). Differences in cardiac structure and geometry, as well as microvascular rarefaction, are evident in midlife after a hypertensive pregnancy, independent of blood pressure. To what extent these phenotypic patterns contribute to cardiovascular disease progression or provide additional measures to improve risk stratification requires further study.",

keywords = "blood pressure, echocardiography, hypertension, magnetic resonance imaging, pre-eclampsia, pregnancy, women",

author = "Henry Boardman and Pablo Lamata and Merzaka Lazdam and Ashley Verburg and Timo Siepmann and Ross Upton and Amy Bilderbeck and Rhys Dore and Clare Smedley and Yvonne Kenworthy and Yrsa Sverrisdottir and Aye, {Christina Y.L.} and Wilby Williamson and Odaro Huckstep and Francis, {Jane M.} and Stefan Neubauer and Lewandowski, {Adam J.} and Paul Leeson",

year = "2020",

month = jun,

day = "1",

doi = "10.1161/HYPERTENSIONAHA.119.14530",

language = "English",

volume = "75",

pages = "1542--1550",

journal = "Hypertension (Dallas, Tex. : 1979)",

issn = "0194-911X",

publisher = "American Heart Association",

number = "6",

}

Boardman, H, Lamata, P, Lazdam, M, Verburg, A, Siepmann, T, Upton, R, Bilderbeck, A, Dore, R, Smedley, C, Kenworthy, Y, Sverrisdottir, Y, Aye, CYL, Williamson, W, Huckstep, O, Francis, JM, Neubauer, S, Lewandowski, AJ & Leeson, P 2020, 'Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated with a History of Hypertensive Pregnancy', Hypertension, vol. 75, no. 6, pp. 1542-1550. https://doi.org/10.1161/HYPERTENSIONAHA.119.14530

TY - JOUR

T1 - Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated with a History of Hypertensive Pregnancy

AU - Boardman, Henry

AU - Lamata, Pablo

AU - Lazdam, Merzaka

AU - Verburg, Ashley

AU - Siepmann, Timo

AU - Upton, Ross

AU - Bilderbeck, Amy

AU - Dore, Rhys

AU - Smedley, Clare

AU - Kenworthy, Yvonne

AU - Sverrisdottir, Yrsa

AU - Aye, Christina Y.L.

AU - Williamson, Wilby

AU - Huckstep, Odaro

AU - Francis, Jane M.

AU - Neubauer, Stefan

AU - Lewandowski, Adam J.

AU - Leeson, Paul

PY - 2020/6/1

Y1 - 2020/6/1

N2 - Hypertensive pregnancy is associated with increased maternal cardiovascular risk in later life. A range of cardiovascular adaptations after pregnancy have been reported to partly explain this risk. We used multimodality imaging to identify whether, by midlife, any pregnancy-associated phenotypes were still identifiable and to what extent they could be explained by blood pressure. Participants were identified by review of hospital maternity records 5 to 10 years after pregnancy and invited to a single visit for detailed cardiovascular imaging phenotyping. One hundred seventy-three women (age, 42±5 years, 70 after normotensive and 103 after hypertensive pregnancy) underwent magnetic resonance imaging of the heart and aorta, echocardiography, and vascular assessment, including capillaroscopy. Women with a history of hypertensive pregnancy had a distinct cardiac geometry with higher left ventricular mass index (49.9±7.1 versus 46.0±6.5 g/m2; P=0.001) and ejection fraction (65.6±5.4% versus 63.7±4.3%; P=0.03) but lower global longitudinal strain (-18.31±4.46% versus -19.94±3.59%; P=0.02). Left atrial volume index was also increased (40.4±9.2 versus 37.3±7.3 mL/m2; P=0.03) and E:A reduced (1.34±0.35 versus 1.52±0.45; P=0.003). Aortic compliance (0.240±0.053 versus 0.258±0.063; P=0.046) and functional capillary density (105.4±23.0 versus 115.2±20.9 capillaries/mm2; P=0.01) were reduced. Only differences in functional capillary density, left ventricular mass, and atrial volume indices remained after adjustment for blood pressure (P<0.01, P=0.01, and P=0.04, respectively). Differences in cardiac structure and geometry, as well as microvascular rarefaction, are evident in midlife after a hypertensive pregnancy, independent of blood pressure. To what extent these phenotypic patterns contribute to cardiovascular disease progression or provide additional measures to improve risk stratification requires further study.

AB - Hypertensive pregnancy is associated with increased maternal cardiovascular risk in later life. A range of cardiovascular adaptations after pregnancy have been reported to partly explain this risk. We used multimodality imaging to identify whether, by midlife, any pregnancy-associated phenotypes were still identifiable and to what extent they could be explained by blood pressure. Participants were identified by review of hospital maternity records 5 to 10 years after pregnancy and invited to a single visit for detailed cardiovascular imaging phenotyping. One hundred seventy-three women (age, 42±5 years, 70 after normotensive and 103 after hypertensive pregnancy) underwent magnetic resonance imaging of the heart and aorta, echocardiography, and vascular assessment, including capillaroscopy. Women with a history of hypertensive pregnancy had a distinct cardiac geometry with higher left ventricular mass index (49.9±7.1 versus 46.0±6.5 g/m2; P=0.001) and ejection fraction (65.6±5.4% versus 63.7±4.3%; P=0.03) but lower global longitudinal strain (-18.31±4.46% versus -19.94±3.59%; P=0.02). Left atrial volume index was also increased (40.4±9.2 versus 37.3±7.3 mL/m2; P=0.03) and E:A reduced (1.34±0.35 versus 1.52±0.45; P=0.003). Aortic compliance (0.240±0.053 versus 0.258±0.063; P=0.046) and functional capillary density (105.4±23.0 versus 115.2±20.9 capillaries/mm2; P=0.01) were reduced. Only differences in functional capillary density, left ventricular mass, and atrial volume indices remained after adjustment for blood pressure (P<0.01, P=0.01, and P=0.04, respectively). Differences in cardiac structure and geometry, as well as microvascular rarefaction, are evident in midlife after a hypertensive pregnancy, independent of blood pressure. To what extent these phenotypic patterns contribute to cardiovascular disease progression or provide additional measures to improve risk stratification requires further study.

KW - blood pressure

KW - echocardiography

KW - hypertension

KW - magnetic resonance imaging

KW - pre-eclampsia

KW - pregnancy

KW - women

UR - http://www.scopus.com/inward/record.url?scp=85084693621&partnerID=8YFLogxK

U2 - 10.1161/HYPERTENSIONAHA.119.14530

DO - 10.1161/HYPERTENSIONAHA.119.14530

M3 - Article

C2 - 32306767

AN - SCOPUS:85084693621

SN - 0194-911X

VL - 75

SP - 1542

EP - 1550

JO - Hypertension (Dallas, Tex. : 1979)

JF - Hypertension (Dallas, Tex. : 1979)

IS - 6

ER -

Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated with a History of Hypertensive Pregnancy

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this