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Original research
Left ventricular mass and myocardial scarring in women with hypertensive disorders of pregnancy
  1. Odayme Quesada1,2,
  2. Ki Park3,
  3. Janet Wei1,2,
  4. Eileen Handberg3,
  5. Chrisandra Shufelt1,2,
  6. Margo Minissian1,2,
  7. Galen Cook-Wiens4,
  8. Parham Zarrini1,2,
  9. Christine Pacheco1,2,
  10. Balaji Tamarappoo1,
  11. Louise E J Thomson5,
  12. Daniel S Berman5,
  13. Carl J Pepine3 and
  14. Noel Bairey Merz1,2
  1. 1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
  2. 2Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
  3. 3Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  4. 4Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
  5. 5S Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Noel Bairey Merz; merz{at}


Aims Hypertensive disorders of pregnancy (HDP) predict future cardiovascular events. We aim to investigate relations between HDP history and subsequent hypertension (HTN), myocardial structure and function, and late gadolinium enhancement (LGE) scar.

Methods and results We evaluated a prospective cohort of women with suspected ischaemia with no obstructive coronary artery disease (INOCA) who underwent stress/rest cardiac magnetic resonance imaging (cMRI) with LGE in the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction study. Self-reported history of pregnancy and HDP (gestational HTN, pre-eclampsia, toxaemia and eclampsia) were collected at enrollment. In our cohort of 346, 20% of women report a history of HDP. HDP history was associated with 3.2-fold increased odds of HTN. Women with a history of both HDP and HTN had higher cMRI measured left ventricular (LV) mass compared with women with HDP only (99.4±2.6 g vs 87.7±3.2 g, p=0.02). While we found a similar frequency of LGE scar, we observed a trend towards increased LGE scar size (5.1±3.4 g vs 8.0±3.4 g, p=0.09) among the women with HDP history compared to women without.

Conclusion In a high-risk cohort of women with suspected INOCA, 20% had a history of HDP. Women with HDP history were more likely to develop HTN. Our study demonstrates higher LV mass in women with HDP and concomitant HTN. Although the presence of LGE scar was not different in women with and without HDP history, we observed a trend towards larger scar size in women with HDP. Future studies are needed to better assess the relationship of HDP and cardiac morphology and LGE scarring in a larger cohort of women.

  • risk factors
  • coronary artery disease
  • hypertension
  • MRI

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  • OQ and KP contributed equally.

  • Contributors NBM and OQ are responsible for the overall content of this article including the planning, conduct and reporting of the work described.

  • Funding This work was supported by contracts from the National Heart, Lung and Blood Institutes (grant numbers N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, U0164829, U01 HL649141, U01 HL649241, K23HL105787, K23HL125941, T32HL69751, R01 HL090957); the National Institute on Aging (grant number 1R03AG032631); National Center for Research Resources General Clinical Research Center (GCRC, grant number MO1-RR00425); the National Center for Advancing Translational Sciences (grant number UL1TR000124 and UL1TR000064); grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ, The Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, CA, The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA, and QMED, Inc, Laurence Harbor, NJ, the Edythe L. Broad and the Constance Austin Women’s Heart Research Fellowships, Cedars-Sinai Medical Center, Los Angeles, California, the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, The Society for Women’s Health Research (SWHR), Washington, DC, The Linda Joy Pollin Women’s Heart Health Program, the Erika J. Glazer Women’s Heart Research Initiative, and the Adelson Family Foundation, Cedars-Sinai Medical Center, Los Angeles, California. Dr Pepine was also supported by National Institute of Health (grant numbers HL33610, HL56921, UM1 HL087366); the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine; NIH NCATS—University of Florida Clinical and Translational Science (grant number UL1TR001427); and PCORnet-OneFlorida Clinical Research Consortium (grant number CDRN-1501-26692). This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or National Institutes of Health.

  • Competing interests Dr Bairey Merz reports personal fees from iRhythm, other from Sanofi, other from Abbott Diagnostics, during the conduct of the study. Dr Handberg reports grants from NIH/NHLBI, during the conduct of the study; grants from Aastom Biosciences, Amgen, Amorcyte, AstraZeneca, Biocardia, Boehringer Ingelheim, Brigham and Women’s Hospital, Capricor, Cytori Therapeutics, Department of Defense, Direct Flow Medical, Duke Clinical Research Institute, East Carolina University, Everyfit Inc, Gilead, Ionis, Medtronic, Merck grants from NIH/NCATS, grants from BioCardia BC-14-001-02; Mesoblast, Inc MSB-MPC-CHF001; Ventrix, Inc; Athersys Inc. AMI MultiStem; Verily Life Sciences LLC-Project Baseline OSMB; Ironwood MSB-MPC-CHF00-DMC, Imbria Pharmaceuticals Inc; Milestone Pharmaceuticals Inc; Caladrius Biosciences, Inc; Gatorade Trust; and McJunkin Family Foundation, outside the submitted work. Dr Minissian reports consulting with Amgen, Medical Advisory Board; honorarium NACCME, LLC Co-Chair for CME; Vox Media; Medtelligence; Minneapolis Heart Institute; Primed; Good Samaritan Hospital, Los Angeles, California; Cardiometabolic Health Congress; American Heart Association; National Lipid Association; Preventive Cardiovascular Nurses Association; American College of Cardiology. All other authors have no disclosures to report.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, NBM, upon reasonable request.

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