Atrial Remodeling in Pregnant Hypertensive Women: Comparison between Chronic and Gestational Hypertension

Left atrial (LA) enlargement is a common finding in hypertensive patients (pts), however little information is available on LA changes during pregnancy. The present study evaluated LA size and function in pregnant women with hypertension.

Patients population included 30 women with chronic hypertension and 30 patients with gestational hypertension. A control group of 16 normotensive pregnant women was selected. Serial echocardiography was performed at 12 and 24 week of gestation in chronic hypertension and at 24 week in gestational hypertension and after delivery. LA diameters and volumes were measured and compared. LA conduit volume, passive and active emptying volumes were calculated. Patients were divided in 2 groups according to max LAV Index > 32 ml/m2 at 24 week of gestation.

Patients with chronic hypertension showed higher LA diameters (42 ± 2.0 vs. 36.5 ± 1.8; p<0.001) and LA volumes (maximal volume 45.5 ± 4.0 vs. 38.1 ± 7.3; p<0.001) compared with patients with gestational hypertension. The median value of max LAVI was 32 + 6.2 ml/m2 in chronic and 26 + 5 ml/m2 in gestational hypertension (p<0.01). During follow-up patients with max LAVI > 32 ml/m2 had more clinical complications evaluated as increase of therapy, fluid retention that need diuretic and hospitalization.

Patients with chronic hypertension showed a more marked increased of LA volumes compared to gestational hypertension due to a remodeling of atrial shape as effect of chronic overload. Patients with more dilated LA volumes developed a greater number of clinical complications suggesting that a dilated LA could be a parameter of hemodynamic instability.