Myocardial remodeling in elderly women with heart failure with preserved ejection fraction: association with a burdened obstetric history

Abstract

Aim. To evaluate structural and functional cardiac parameters in elderly women with heart failure with preserved ejection fraction (HFpEF) in association with unfavorable pregnancy factors and outcomes in history. Material and methods . This cross-sectional study included 80 women aged 60-74 years with HFpEF and a history of pregnancy. All patients underwent echocardiography to assess the structural and functional parameters of the left heart. Obstetric history was collected using a standardized interview. Results. Unfavorable factors and pregnancy outcomes in history were independently associated with an increase in left ventricular mass (LVM) (β=2,36 g; 95% confidence interval (CI): 0,94-3,78; p=0,002), relative left ventricular wall thickness (β=0,029; 95% CI: 0,005-0,053; p=0,016) and interventricular septal thickness (β=0,71 mm; 95% CI: 0,13-1,29; p=0,018). When analyzing individual factors, delivery of a big fetus was associated with an increase in absolute LVM (β=17,37 g; 95% CI: 1,32-33,42; p=0,036) and LVM index (β=19,59 g/m2; 95% CI: 5,49-33,69; p=0,011) and interventricular septal thickness (β=0,87 mm; 95% CI: 0,27-1,47; p=0,006). Hypertensive disorders of pregnancy were associated with an increase in the relative left ventricular wall thickness (β=0,030; 95% CI: 0,001-0,059; p=0,044). Conclusion. In elderly women with HFpEF, a history of obstetric complications is associated with specific patterns of myocardial hypertrophy and concentric remodeling, suggesting its contribution to a distinct disease phenotype.