Eur Heart J Imaging Methods Pract. 2026 Aug 20;4(3):qyag145. doi: 10.1093/ehjimp/qyag145. eCollection 2026 Aug.

ABSTRACT

AIMS: Hypertensive pregnancies affect up to 10% of pregnancies globally and are linked to greater cardiovascular risk in offspring. Subclinical cardiac changes have been reported across developmental stages. This study aimed to assess whether children born to hypertensive pregnancies exhibit altered left ventricular (LV) morphology and cardiac flow characteristics.

METHODS AND RESULTS: In this cross-sectional study, cardiovascular magnetic resonance (CMR) was performed on a 3.0-Tesla Siemens PRISMA scanner in children aged 6-9 years: 44 offspring of hypertensive pregnancies (50% female) and 56 controls from normotensive pregnancies (37.5% female). Free-breathing real-time cine images were acquired to assess structure and function and to create a computational LV shape atlas. Four-dimensional (4D) Flow CMR was acquired to quantify LV flow component volumes and kinetic energy (KE), enabling assessment of intraventricular flow organization and energetics. Children born to hypertensive and normotensive pregnancies were matched in age (7.49 ± 0.73 and 7.41 ± 1.12 years), but those from hypertensive pregnancies had significantly shorter gestations (median 37.3 weeks [IQR 35.6-39.0] vs. 39.0 weeks [37.7-40.8], P = 0.002). Conventional cardiac measures did not differ between groups. Exploratory shape analysis identified subtle group-level LV differences, including relative prominence of the basal anterior wall, and a more convex LV outflow tract (P < 0.01; AUC = 0.654). LV retained inflow end-diastolic KE was lower in exposed offspring (3.35 [3.03-4.80] vs. 5.70 [4.35-6.80] μJ/mL; P < 0.001).

CONCLUSION: Children born to hypertensive pregnancies show subtle group-level differences in LV morphology and diastolic flow energetics. These findings suggest early differences in cardiovascular phenotype, although their long-term clinical significance remains uncertain and requires longitudinal investigation.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT05698836.

LAY SUMMARY: This study investigated whether children born to mothers with high blood pressure during pregnancy show early differences in heart structure and blood flow.Children exposed to high blood pressure during pregnancy had subtle differences in heart shape and blood flow patterns.The differences identified were small and could only be detected using advanced heart imaging analyses. They were seen when comparing groups of children rather than being useful for identifying individual children, and their long-term importance is not yet known.

PMID:42699537 | PMC:PMC13543680 | DOI:10.1093/ehjimp/qyag145