Correlation between multi-parameter echocardiographic indicators and adverse pregnancy outcomes in women of advanced maternal age with pregnancy-induced hypertension syndrome: clinical application value

Overview

This retrospective study examined the relationship between multi-parameter echocardiographic indicators and adverse pregnancy outcomes in 240 women aged 35 years or older with pregnancy-induced hypertension syndrome. Echocardiographic parameters including systolic and diastolic function measures, chamber remodeling indices, and tissue Doppler velocities were evaluated as potential predictors of adverse maternal and fetal outcomes in this high-risk population.

Methods and approach

A retrospective cohort of 240 women with PIHS was stratified into favorable outcome (n=183) and adverse outcome (n=57) groups. Echocardiographic assessment encompassed systolic function metrics (ejection fraction, stroke volume, cardiac output), diastolic function parameters (E/A ratio, early diastolic mitral annular velocity, E/E' ratio), structural indices (left atrial volume index), and hemodynamic measures (pulmonary venous flow velocities, myocardial performance index). Between-group comparisons were conducted with multivariable logistic regression analysis and receiver operating characteristic curve analysis to evaluate discriminative capacity of individual and combined parameters.

Key Findings

Women in the adverse outcome group demonstrated significantly reduced ejection fraction, stroke volume, cardiac output, E/A ratio, and E' velocity, concurrent with elevated E/E' ratio, left atrial volume index, atrial reversal wave velocity, and myocardial performance index, alongside diminished systolic and diastolic pulmonary venous flow velocities (all p<0.001). Clinical risk factors including antecedent hypertension, nephritis history, and familial hypertension were independently associated with adverse outcomes. Multivariable logistic regression confirmed independent associations for both clinical and echocardiographic variables with poor outcomes. Individual echocardiographic indices demonstrated area under the curve values ranging from 0.78 to 0.90, while a composite model integrating multiple echocardiographic parameters achieved an area under the curve of 0.925.

Implications

Multi-parameter echocardiographic assessment provides a non-invasive, objective methodology for stratifying risk in advanced maternal age women with pregnancy-induced hypertension syndrome. The high discriminative performance of the combined echocardiographic model suggests utility for clinical decision-making regarding intensity of monitoring and timing of therapeutic interventions. Integration of echocardiographic assessment with established clinical risk factors may enhance predictive accuracy for adverse outcomes in this population.