Speckle Tracking Echocardiography in Hypertensive Pregnancy Disorders: A Systematic Review
Suzanne Moors, Noortje H. M. van Oostrum, Chiara Rabotti, Xi Long, Michelle E.M.H. Westerhuis, Hareld Kemps, S. Guid Oei, Judith O. E. H. van Laar
Abstract
Importance Hypertensive pregnancy disorders (HPDs) are associated with an increased risk of long-term cardiovascular disease. Speckle tracking echocardiography (STE) might be useful in the early detection of preclinical cardiac changes in women with HPDs. Objective The aim of this study was to study whether STE is a suitable method to detect differences in cardiac function in pregnant women with HPD compared with normotensive pregnant women or between women with a history of a pregnancy complicated by HPD compared with women with a history of an uncomplicated pregnancy. Evidence Acquisition The databases Medline, EMBASE, and Central were systematically searched for studies comparing cardiac function measured with STE in pregnant women with HPD or women with a history of HPD and women with a history of normotensive pregnancies. Results The search identified 16 studies, including 870 women with a history of HPD and 693 normotensive controls. Most studies during pregnancy (n = 12/13) found a decreased LV-GLS (left ventricular global longitudinal strain) in HPD compared with normotensive pregnant controls. LV-GRS (left ventricular global radial strain) and LV-GLCS (left ventricular global circumferential strain) are decreased in women with early-onset and severe preeclampsia. Women with a history of early-onset preeclampsia show lasting myocardial changes, with significantly decreased LV-GLS, LV-GLCS, and LV-GRS. Conclusions and Relevance LV-GLS is significantly decreased in pregnant women with HPD compared with normotensive pregnant women. Other deformation values show a significant decrease in women with severe or early-onset preeclampsia, with lasting myocardial changes after early-onset preeclampsia. Target Audience Obstetricians and gynecologists, family physicians, cardiologists. Learning Objectives After participating in this activity, the learner should be better able to identify the test characteristics of STE; describe the differences in STE between HPDs and normotensive pregnant controls; and explain which HPD causes lasting myocardial changes after pregnancy.