Banca de DEFESA: RICARDO LUIZ DE MEDEIROS LIMA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : RICARDO LUIZ DE MEDEIROS LIMA
DATE: 12/09/2025
TIME: 14:00
LOCAL: Remota - https://meet.google.com/umm-nxjf-gkj
TITLE:

LEFT VENTRICULAR DYSFUNCTION IN PREGNANCY WITH HYPERTENSIVE DISORDERS OF PREGNANCY

KEY WORDS:

Hypertensive disorders of pregnancy; preeclampsia; ventricular dysfunction; echocardiography; Brazil

PAGES: 63
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Hypertensive Disorders of Pregnancy (HDP) comprise a group of conditions characterized by elevated blood pressure (≥140/90 mmHg, measured on at least two occasions with a minimum interval of 4 hours) that occur during pregnancy, childbirth, or the postpartum period, and may or may not be associated with proteinuria and/or signs of target-organ damage. They include conditions such as preexisting pregnancy (chronic hypertension) and those that develop after pregnancy begins (gestational hypertension, preeclampsia, eclampsia, and superimposed preeclampsia). These disorders have a significant impact on maternal and fetal health. Women who develop preeclampsia, as well as the children born from such pregnancies, have an increased risk of future cardiovascular events. Transthoracic echocardiography with analysis of the Left Ventricular (LV) Global Longitudinal Strain (GLS) has proven to be a sensitive tool for the early detection of myocardial dysfunction, including subclinical forms. This study aimed to evaluate, through this technique, early signs of cardiovascular impairment in pregnancy. A longitudinal study was conducted throughout pregnancy, along with a cross-sectional study in the immediate postpartum period, involving women who developed severe preeclampsia, using echocardiography to assess ventricular function. Between February 2018 and March 2020, 107 pregnant women and 20 postpartum women with a history of severe preeclampsia were evaluated in Natal, Rio Grande do Norte, Brazil. Participants underwent serial echocardiograms, along with the collection of clinical, obstetric, and anthropometric data. Ventricular function was analyzed using conventional parameters and GLS. Statistical analyses included logistic regression, correlations, univariate analysis, and canonical correlation. Of the 107 pregnant women recruited, 87 were followed until the end of the study. Forty (47.1%) were primigravidas, aged between 16 and 38 years (mean 28.12 ± 6.35 years). Sixty-one (70.1%) were overweight or obese (BMI >25 kg/m²), with 36 (41.4%) overweight, 23 (26.4%) with grade I or II obesity, and 2 (2.3%) with grade III obesity. Myocardial hypertrophy or remodeling was identified in 12 women (13.8%). LV ejection fraction was below 50% in 4 cases (4.6%), while GLS was below 18% in 6 cases (6.9%). The correlation matrix showed no significant association between ventricular function parameters and other echocardiographic, anthropometric, obstetric, or clinical variables. However, the comparison between the first and last echocardiogram of the same pregnant women revealed, through univariate analysis, significant differences in LV diastolic diameter (p=0.0133), LV mass index (p=0.0034), LV relative wall thickness (p=0.0274), and mitral inflow E/A ratio (p=0.0009). These findings indicate the physiological cardiac changes induced by a normal pregnancy. When comparing pregnant women with and without HDP, significant differences were observed in BMI (p=0.0365), LV mass index (LVMI) (p=0.0350), and mitral E/A ratio (p=0.0013). Postpartum women with a history of severe preeclampsia showed altered echocardiographic parameters compared to pregnant women without HDP, such as LVMI (p=0.0185), LV relative wall thickness (p=0.0007), mitral E/A ratio (p=0.0072), LV isovolumic relaxation time (IVRT) (p=0.0002), and GLS (p=0.0429). Canonical correlation analysis demonstrated moderate associations between anthropometric parameters and diastolic function (ρ=0.65, p<0.001), hypertensive parameters and diastolic function (ρ=0.64, p<0.001), anthropometric and hypertensive parameters (ρ=0.57, p<0.001), and hypertensive parameters and systolic function (ρ=0.57, p<0.001). Weak correlations were found between anthropometric parameters and systolic function (ρ=0.49, p=0.002), anthropometric and obstetric parameters (ρ=0.43, p=0.003), and hypertensive and obstetric parameters (ρ=0.39, p=0.045). These findings demonstrate a significant association between BMI, LVMI, and diastolic function in pregnant women with HDP. Postpartum women who developed severe preeclampsia presented relevant alterations in LVMI, LV relative wall thickness, mitral E/A ratio, IVRT, and GLS, even with preserved ejection fraction. Therefore, transthoracic echocardiography with GLS analysis was able to detect subclinical alterations in left ventricular systolic function in women with severe HDP. These findings reinforce the importance of cardiovascular follow-up during both pregnancy and the postpartum period, especially in cases of HDP, aiming to prevent medium- and long-term maternal–fetal cardiovascular complications.

COMMITTEE MEMBERS:
Externa à Instituição - GLÁUCIA MARIA MORAES OLIVEIRA - UFRJ
Externa ao Programa - 1149381 - ANA CRISTINA PINHEIRO FERNANDES DE ARAUJO - nullExterno ao Programa - 3314288 - LUIZ MURILLO LOPES DE BRITTO - nullExterna à Instituição - MARIA SANALI MOURA DE OLIVEIRA PAIVA - IAPC
Presidente - 350647 - SELMA MARIA BEZERRA JERONIMO