LVH on early-pregnancy echocardiography predicts adverse maternal and fetal outcomes in chronic hypertension

In 500 pregnant women with chronic hypertension, left ventricular hypertrophy (LVH) on early echocardiography was independently associated with adverse maternal outcomes (OR 2.16, 95% CI 1.13-4.13) and fetal outcomes (OR 2.42, 95% CI 1.31-4.45).

• Machine learning models predicted adverse outcomes with AUCs of 0.70-0.87 for maternal and 0.80-0.88 for fetal events; LVH was a top contributor by SHAP analysis.
• Additional maternal predictors included NYHA class III-IV, pre-eclampsia, oligohydramnios, elevated liver enzymes, hypoalbuminemia, and blood transfusion; fetal predictors included increased posterior wall thickness, oligohydramnios, and abnormal umbilical artery flow.
• The predictive models require prospective external validation before clinical implementation.

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