Methods
This is a cross-sectional study and contains 195 women patients. All patients with a history of one or more delivery and above 18 years-of-age were included in this study. Patients under 18 years-of-age, history of coronary artery disease, heart failure, structural heart diseases, rhythm disorders, renal or hepatic disorders and women who are currently pregnant were excluded from the study. However, patients with a history of hypertension and diabetes mellitus that may affect left ventricular diastolic functions were included to study. Binary and multinominal logistic regression analyses were done for two of these situations
Women with one delivery history was defined as primiparous (PP), 2 to 5 deliveries were defined as multiparous (MP), 5 to 9 deliveries were defined as grand multiparous (GMP) and more than 9 deliveries were defined as great grand multiparous (GGMP).
Echocardiographic (Vivid 7 system with 3S echocardiography probe, GE Vingmed Ultrasound AS, Horten, Norway) evaluation was done by trained cardiology specialists. The evaluated parameters were peak early filling velocity during atrial systole (E), peak filling velocity during atrial systole (A), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter, left ventricular end-diastolic diameter, lateral e’ velocity, lateral s’ velocity, septal e’ velocity, septal s’ velocity, tricuspid S velocity. E / A was calculated as the ratio of E to A. E / e’ ratio was calculated as the ratio of E velocity to mean e’ (as average of lateral e’ wave and septal e’ wave).
Septal e’ ≥ 8 cm / sec, lateral e’ ≥10 cm / sec was evaluated as normal diastolic function. Diastolic dysfunction was determined to be septal e ’<8 cm / sec, lateral e’<10 cm / sec. Stage 1 diastolic dysfunction was defined as; mitral E and A wave velocity ratio (E / A) < 0.8, the ratio of E to the mean early diastolic mitral annular velocity (E/e’) ≤ 8. Stage 2 diastolic dysfunction was determined as E / A to be between 0.8-1.5 and E / e’ ratio between 9 and 12. Stage 3 diastolic dysfunction was determined as E / A ratio being ≥ 2 and E / mean e’ ratio was ≥ 13. All these parameters were obtained American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) guidelines recommendations[13].
Hypertension was defined as systolic pressure greater than 140 mm Hg or diastolic pressure greater than 90 mm Hg or a history of hypertension with the use of antihypertensive medication. Diabetes mellitus was defined as a fasting blood glucose level of 126 mg/dl, a random glucose measurement of 200 mg/dl, hemoglobin A1c >6.5%, or a previous diagnosis with any use of anti-diabetic medication.
Datas were presented as mean ± standard deviation (SD) for continuous variables and as numbers and proportions for categorical variables. Distribution of the data for normality was tested by the Shapiro–Wilk test and homogeneity of group variances were tested by the Levene test. The t-test or Chi-square test was used for comparisons of continuous and categorical variables, respectively. For the parameters which are not normally distributed, Mann Whitney U test was used. More than two independent groups with normal distribution were compared with the ANOVA test. Binary logistic regression analysis was used to identify the associations of diastolic dysfunction presence to other variables. Multinominal regression analysis was used to evaluate the associations of diastolic dysfunction grades to other variables. The data analyses were performed with SPSS 23.0 (IBM SPSS Ver. 23.0, IBM Corp, Armonk NY, USA). A p-value of <0.05 was considered significant.