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Incremental prognostic value of global left atrial peak strain in women with new-onset gestational hypertension

Sonaglioni, Andreaa; Lonati, Chiarab; Lombardo, Michelea; Rigamonti, Elisabettaa; Binda, Giuliaa; Vincenti, Antonioa; Nicolosi, Gian L.c; Bianchi, Stefanod; Harari, Sergioe,f; Anzà, Claudiog

doi: 10.1097/HJH.0000000000002086

Background: Left atrial strain and strain rate parameters, measured by bidimensional-speckle tracking echocardiography, have been proposed as predictors of atrial fibrillation, stroke, congestive heart failure and cardiovascular death. However, they have not yet been tested in hypertensive disorders of pregnancy. The aim of this study was to assess the prognostic role of global left atrial peak strain (GLAPS) in a population of pregnant women with new-onset hypertension in a medium-term follow-up.

Methods: Twenty-seven consecutive women with new-onset hypertension after 20 weeks pregnancy and 23 age-matched, race-matched and gestational week-matched consecutive normotensive pregnant women were enrolled in this prospective study. All participants underwent a complete echocardiographic study with bidimensional-speckle tracking echocardiography and carotid examination. At 1-year follow-up, we evaluated the occurrence of persistent hypertension.

Results: In comparison with normotensive women, those hypertensive had a higher burden of cardiovascular risk factors, similar left atrial volume indexed (P = 0.14), but severely impaired left atrial strain (P < 0.0001) and strain rate values (P < 0.0001). At 1-year follow-up, persistent hypertension was documented in 59.3% of patients. At the univariate Cox analysis, the variables associated with the occurrence of the investigated outcome in all hypertensive pregnancies were SBP (hazard ratio 1.04, P = 0.04), DBP (hazard ratio 1.11, P = 0.01), mean arterial pressure (hazard ratio 1.09, P = 0.01) values and the GLAPS value (hazard ratio 0.85, P = 0.0019). The latter was significantly associated with the investigated outcome both in preeclamptic (hazard ratio 0.84, P = 0.02) and nonpreeclamptic pregnant women (hazard ratio 0.83, P = 0.04). The receiver operating characteristics curve analysis highlighted that a GLAPS value of 23.5% or less predicted persistent hypertension with sensitivity of 100% and specificity of 90.90%.

Conclusion: In hypertensive pregnant women a GLAPS value of 23.5% or less reveals a greater severity of atrial cardiomyopathy and might predict postpregnancy persistent hypertension.

aDepartment of Cardiology

bDepartment of Internal Medicine, Ospedale San Giuseppe MultiMedica, Milan

cCardiology Clinic, Policlinico San Giorgio, Pordenone

dDepartment of Gynecology and Obstetrics

eDepartment of Pneumology

fSemi-Intensive Care Unit, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica

gCardiovascular Department, MultiMedica IRCCS, Milan, Italy

Correspondence to Andrea Sonaglioni, MD, Department of Cardiology, Ospedale San Giuseppe Multimedica, Via San Vittore 12, 20123 Milan, Italy. Tel: +00 39 3339237137; e-mail:

Abbreviations: AUC, area under the curve; BP, blood pressure; CCA, common carotid artery; EDD, end-diastolic diameter; GFR, glomerular filtration rate; GLAPS, global left atrial peak strain; GSA+, positive global atrial strain; HELLP, hemolysis, elevated liver enzymes, low platelet count; IMT, intima–media thickness; LAVi, left atrial volume indexed; LV, left ventricular; LVFP, left ventricular filling pressure; LVMi, left ventricular mass indexed; MAP, mean arterial pressure; ROC, receiver operating characteristics; STE, speckle tracking echocardiography; SV, istroke volume indexed

Received 1 December, 2018

Revised 6 February, 2019

Accepted 18 February, 2019

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