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Aldo C, Martina Z, Alberto A, Mario P. Cardiovascular risk evaluation in pregnancy: focus on cardiac specific biomarkers. Clin Chem Lab Med 2024; 62:581-592. [PMID: 37942796 DOI: 10.1515/cclm-2023-0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
Despite the evidence demonstrating the clinical utility of cardiac specific biomarkers in improving cardiovascular risk evaluation in several clinical conditions, even the most recent reviews and guidelines fail to consider their measurement in order to enhance the accuracy of the evaluation of cardiovascular risk in pregnant women. The aim of this review article was to examine whether the assay of cardiac specific biomarkers can enhance cardiovascular risk evaluation in pregnant women, first by reviewing the relationships between the physiological state of pregnancy and cardiac specific biomarkers. The clinical relevance of brain natriuretic peptide (BNP)/NT-proBNP and high-sensitivity cardiac troponin I/high-sensitivity cardiac troponin T (hs-cTnI/hs-cTnT) assay in improving cardiovascular risk evaluation is examined based on the results of clinical studies on subjects with normal and those with complicated pregnancy. Finally, the analytical approaches and clinical objectives related to cardio specific biomarkers are advocated in order to allow an early and more accurate evaluation of cardiovascular risk in pregnant women.
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Affiliation(s)
- Clerico Aldo
- Coordinator of the Study Group on Cardiac Biomarkers from Italian Society of Biochemical Chemistry (SIBioC) and European Ligand Assay Society (ELAS), Milan, Italy
| | - Zaninotto Martina
- Department of Laboratory Medicine, University-Hospital Padova, Padova, Italy
| | - Aimo Alberto
- Fondazione CNR - Regione Toscana G. Monasterio, Pisa, Italy
| | - Plebani Mario
- Department of Medicine, University of Padova, Padova, Italy
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Nichting TJ, de Vet CM, van der Ven M, van der Woude DAA, Regis M, van Sloun RJG, Oei SG, van Laar JOEH, van Oostrum NHM. The impact of angles of insonation on left and right ventricular global longitudinal strain estimation in fetal speckle tracking echocardiography. PLoS One 2023; 18:e0287003. [PMID: 37437044 DOI: 10.1371/journal.pone.0287003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/28/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES Two-dimensional speckle tracking echocardiography has been considered an angle-independent modality. However, current literature is limited and inconclusive on the actual impact of angle of insonation on strain values. Therefore, the primary objective of this study was to assess the impact of angles of insonation on the estimation of fetal left ventricular and right ventricular global longitudinal strain. Secondarily, the impact of different definitions for angles of insonation was investigated in a sensitivity analysis. METHODS This is a retrospective analysis of a prospective longitudinal cohort study with 124 healthy subjects. The analyses were based on the four-chamber view ultrasound clips taken between 18+0 and 21+6 weeks of gestation. Angles of insonation were categorized into three groups: up/down, oblique and perpendicular. The mean fetal left and right ventricular and global longitudinal strain values corresponding to these three groups were compared by an ANOVA test corrected for heteroscedasticity. RESULTS Fetal left and right ventricular global longitudinal strain values were not statistically different between the three angles of insonation (p-value >0.062 and >0.149, respectively). When applying another definition for angles of insonation in the sensitivity analysis, the mean left ventricular global longitudinal strain value was significantly decreased for the oblique compared to the up/down angle of insonation (p-value 0.041). CONCLUSIONS There is no evidence of a difference in fetal left and right ventricular global longitudinal strain between the different angles of insonation in fetal two-dimensional speckle tracking echocardiography.
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Affiliation(s)
- Thomas J Nichting
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Chantelle M de Vet
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Myrthe van der Ven
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Daisy A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Marta Regis
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Ruud J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - S Guid Oei
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
| | - Judith O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima MC, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Centre, Eindhoven, The Netherlands
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Pan M, Li W, Guo X, Mao Y, Peng X, Sun X, Huang C, Wang B, Zhao B. Preliminary study on the evaluation of mitral annulus displacement in normal fetuses by automated cardiac motion quantitation. J Matern Fetal Neonatal Med 2022; 35:5872-5880. [PMID: 33706654 DOI: 10.1080/14767058.2021.1900102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess the characteristics of mitral annular plane systolic excursion (MAPSE) in different longitudinal directions in normal fetuses using a new method, automatic cardiac motion quantification (aCMQ). METHODS A cross-sectional study was conducted in 164 fetuses with structurally normal hearts. The time-displacement curves of the septal mitral annulus (SMA) in three directions, including point A, B and C (MAPSE-SMA-A, MAPSE-SMA-B, MAPSE-SMA-C), were recorded by aCMQ. The time to peak (TTP) in three directions, including point A, B and C (TTP-SMA-A, TTP-SMA-B, TTP-SMA-C) were recorded. In the same way, various parameters of the lateral mitral annulus (LMA) were obtained including MAPSE-LMA-A, MAPSE-LMA-B, MAPSE-LMA-C, TTP-LMA-A, TTP-LMA-B and TTP-LMA-C. Free angle M-mode echocardiography (FAM) was used to obtain MAPSE of LMA (FAM-MAPSE). Finally, all the data were analyzed statistically. RESULTS MAPSE was positively correlated with gestational age, and the difference between the second- and third-trimester groups was statistically significant. MAPSE-LMA in point B and C were greater than those of SMA. MAPSE-LMA-C and MAPSE-SMA-A were the largest in three directions.The difference between point B and C were statistically significant (p < .05), with no significant difference at point A (p > .05). There was no significant difference found in all TTP (all p > .05). The MAPSE-LMA-C was less than the FAM-MAPSE, and the differences were found significantly (p < .05), but there was better correlation (p < .05). CONCLUSIONS The longitudinal movement of the fetal mitral annulus is comprehensive, with multiple directions and different displacements. Perpendicular to the mitral annulus is the maximum displacement. It is positively related to the gestational age. From the second trimester, the longitudinal contraction of the left ventricle wall has good synchronization. It possesses clinical value in selecting different methods and parameters during evaluating left ventricular function.
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Affiliation(s)
- Mei Pan
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Wengang Li
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xianfeng Guo
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yankai Mao
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaohui Peng
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaolu Sun
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Chao Huang
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Bei Wang
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
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Wan L, Tang J, Xiao Y, Li H, Peng Z, Xu DY, Shen L. Improvement of hemodynamic parameters in aortic stenosis patients with transcatheter valve replacement by using impedance cardiography. Front Cardiovasc Med 2022; 9:950437. [PMID: 36204567 PMCID: PMC9530126 DOI: 10.3389/fcvm.2022.950437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background The hemodynamic changes of patients with aortic stenosis (AS) who underwent transcatheter valve replacement (TAVR) have not been completely investigated. Methods and results We enrolled 74 patients with AS who underwent TAVR and assessed cardiac function changes at 1 week post-operation by impedance cardiography (ICG) in a supine position at rest for more than 15 min. Of the 74 patients, 47 had preserved left ventricular ejection fraction (LVEF ≥ 50%; preserved-LVEF group) and 27 had reduced LVEF (LVEF <50%; reduced-LVEF group). TAVR improved the cardiac structure and function, as evidenced by the decrease in the left ventricular end-diastolic (LVED), left atrial diameter (LAD), and an increase in the LVEF. We observed a decrease in N-terminal pro-brain natriuretic peptide (NT-proBNP) level compared to that before treatment. Moreover, patients with reduced LVEF had a more significant reduction of NT-proBNP than those with preserved LVEF. Meanwhile, the blood pressure of patients had no significant differences pre- and post-operation. Based on ICG, there were no changes in the parameter of cardiac preload [thoracic fluid content (TFC)]. We observed an improvement in parameters of diastolic cardiac function [left ventricular ejection time (LVET) and pre-ejection period (PEP)]. And we detected converse results in parameters of heart systolic function [systolic time ratio (STR), cardiac output (CO), cardiac index (CI), stroke index (SI), and stroke volume (SV)] and cardiac afterload [stroke systemic vascular resistance (SSVR) and SSVR-index (SSVRI)]. In addition, TFC level was decreased in patients with thoracic volume overload after valve replacement. Subgroup analysis showed that the changes in those parameters were more noticeable in patients with reduced LVEF than that with preserved LVEF. Moreover, we observed no effects on parameters of heart systolic function and heart afterload in the LVEF ≥ 50% group before and after TAVR. Conclusion Our data revealed a beneficial effect of TAVR in diastolic function and preload as detected by the ICG. But the LV systolic function and cardiac afterload were not improved in patients with LVEF <50%. The result indicated that ICG could be used as an important technique to monitor the cardiac condition of patients after aortic valve replacement.
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van Oostrum NHM, de Vet CM, Clur SB, van der Woude DAA, van den Heuvel ER, Oei SG, van Laar JOEH. Fetal myocardial deformation measured with two-dimensional speckle-tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:651-659. [PMID: 34558747 PMCID: PMC9321172 DOI: 10.1002/uog.24781] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Two-dimensional speckle-tracking echocardiography (2D-STE) is a promising technique which allows assessment of fetal cardiac function, and can be used in the evaluation of cardiac and non-cardiac diseases in pregnancy. However, reliable fetal reference values for deformation parameters measured using 2D-STE are needed before it can be introduced into clinical practice. This study aimed to obtain reference values for fetal global longitudinal strain (GLS) and GLS rate (GLSR) measured using 2D-STE and compare right and left ventricular values. METHODS This was a prospective longitudinal cohort study of uncomplicated pregnancies that underwent echocardiography every 4 weeks from inclusion at 18-21 weeks until delivery to obtain four-chamber loops of the fetal heart. Left and right ventricular GLS and GLSR were measured using 2D-STE at each examination. Using Bayesian mixed-effects models, reference values with lower and upper 5% prediction limits were calculated according to gestational age. Right and left ventricular GLS values according to gestational age were compared using the Wilcoxon signed-rank test. RESULTS A total of 592 left ventricular and 566 right ventricular GLS and GLSR measurements were obtained from 124 women with uncomplicated pregnancy and non-anomalous, appropriately grown fetuses. Reference values were obtained for both fetal ventricles according to gestational week. GLS and GLSR values of both ventricles increased (i.e. became less negative) significantly during pregnancy. Right ventricular GLS values were significantly higher (i.e. less negative) than the respective left ventricular values at every gestational week. CONCLUSIONS Reference values were obtained for fetal GLS and GLSR measured using 2D-STE. GLS and GLSR values increased significantly for both ventricles from the second trimester until delivery. GLS values were significantly higher for the right ventricle compared with the left ventricle. Future studies are needed to assess whether the obtained reference values are helpful in clinical practice in the assessment of pregnancy complications, such as fetal growth restriction or cardiac anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N. H. M. van Oostrum
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsGhent UniversityGhentBelgium
| | - C. M. de Vet
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| | - S. B. Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical CenterAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - D. A. A. van der Woude
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| | - E. R. van den Heuvel
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Mathematics & Computer ScienceEindhoven University of TechnologyEindhovenThe Netherlands
| | - S. G. Oei
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| | - J. O. E. H. van Laar
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
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Tadic M, Cuspidi C, Suzic Lazic J, Vukomanovic V, Mihajlovic S, Savic P, Cvrkotic M, Grassi G, Celic V. Blood pressure variability correlates with right ventricular strain in women with gestational hypertension and preeclampsia. J Hum Hypertens 2022; 36:826-832. [PMID: 34272473 PMCID: PMC8284030 DOI: 10.1038/s41371-021-00580-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 01/22/2023]
Abstract
The aim of this study was to evaluate the short- and long-term blood pressure (BP) variability and right ventricular (RV) remodeling in women with gestational hypertension and preeclampsia, as well as their association. This cross-sectional study included 161 pregnant women (56 normotensive controls, 55 patients with gestational hypertension, and 50 patients with preeclampsia) after 20 weeks of gestation. All women underwent 24-h ambulatory BP monitoring and echocardiographic examination. Our findings showed that 24-h, daytime and nighttime systolic and diastolic BPs, as well as visit-to-visit systolic and diastolic BPs, were significantly higher in women with gestational hypertension and preeclampsia than in control group. Parameters of short- and long-term BP variability gradually increased from controls, throughout women with preeclampsia, to those with gestational hypertension. RV diameter, E/e' and PAP were significantly higher in women with gestational hypertension and preeclampsia than in controls. Global and free wall RV longitudinal strains, as well as corresponding endo- and epicardial strains, gradually reduced from controls to women with preeclampsia. Parameters of short- and long-term BP variability were independently associated with global and free wall RV longitudinal strain. In conclusion, short- and long-term BP variability was higher in women with pregnancy-induced hypertensive disorders. RV diastolic function and mechanics were deteriorated in these women comparing with controls. A significant association between BP variability and RV longitudinal strain underlines the importance of determination of short- and long-term BP variability during pregnancy.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Clinic for Internal medicine, Cardiology Department, Belgrade, Serbia.
| | - Cesare Cuspidi
- University of Milan-Bicocca and Istituto, Auxologico Italiano Clinical Research Unit, Meda, Italy
| | - Jelena Suzic Lazic
- grid.449714.bUniversity Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”, Clinic for Internal medicine, Cardiology Department, Belgrade, Serbia
| | - Vladan Vukomanovic
- grid.449714.bUniversity Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”, Clinic for Internal medicine, Cardiology Department, Belgrade, Serbia
| | - Sladjana Mihajlovic
- grid.449714.bUniversity Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”, Clinic for gynecology, Belgrade, Serbia
| | - Predrag Savic
- grid.449714.bUniversity Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”, Clinic for Internal medicine, Cardiology Department, Belgrade, Serbia
| | - Marko Cvrkotic
- grid.449714.bUniversity Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”, Clinic for Internal medicine, Cardiology Department, Belgrade, Serbia
| | - Guido Grassi
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Vera Celic
- grid.449714.bUniversity Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”, Clinic for Internal medicine, Cardiology Department, Belgrade, Serbia
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Lee-Tannock A, Hay K, Kumar S. Differences in biomarkers of cardiac dysfunction in cord blood between normal pregnancies and pregnancies complicated by maternal diabetes. Aust N Z J Obstet Gynaecol 2021; 62:79-85. [PMID: 34370294 DOI: 10.1111/ajo.13415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/25/2021] [Accepted: 07/13/2021] [Indexed: 01/05/2023]
Abstract
AIMS The aim of this study was to compare biomarkers of cardiac dysfunction in cord blood in women with uncomplicated pregnancies and pregnancies complicated by maternal pre-gestational and gestational diabetes and to correlate these findings with fetal echocardiography parameters of cardiac function. MATERIAL AND METHODS Fetal echocardiographic assessment was performed longitudinally on 78 fetuses in the normal cohort and 32 in the diabetic cohort by measuring tricuspid annular plane systolic excursion, mitral annular plane systolic excursion, myocardial performance index, interventricular septum (IVS) thickness and left fractional shortening between July 2015 and December 2017. Cord blood samples were obtained at birth and levels of troponin I (TnI), B-type natriuretic peptide (BNP) and the amnio terminal segment of its prohormone measured. RESULTS Women with diabetes had significantly higher median body mass index and mean z-scores for BNP. Significant associations were observed between maternal diabetes and obesity and cord-blood BNP z-scores. The effect of diabetes on TnI levels were similar, with mean values higher in women with gestational diabetes compared to normal pregnancies; however, this difference did not reach statistical significance. These biomarker findings correlated with an increased IVS thickness in the diabetic group. No difference was demonstrated in the other cardiac function parameters measured. CONCLUSION Biochemical markers of cardiac dysfunction are elevated in infants of diabetic and obese mothers and correlated with increased IVS thickness.
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Affiliation(s)
- Alison Lee-Tannock
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Mater Health Services, Brisbane, Queensland, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Health Services, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Erdol MA, Tanacan A, Eroglu H, Tonyali NV, Erdogan M, Yucel A, Yazihan N, Sahin D. Pro-BNP Levels and Its Prognostic Role in Chronic Hypertensive Pregnancies: A Prospective Case-Control Study From A Tertiary Care Hospital. Hypertens Pregnancy 2021; 40:202-208. [PMID: 34143704 DOI: 10.1080/10641955.2021.1939712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aimed to investigate the prognostic value of N-terminal B-type natriuretic peptide (NT-proBNP) in pregnancies with isolated chronic hypertension (HT). METHOD 34 pregnant women with chronic HT and 40normotensive controls were enrolled. The association between plasma NT-proBNP levels obtained in the first trimester and perinatal complications were evaluated. RESULTS NT-proBNP levelsstrongly predicted low birth weight (AUC=0.842, p<0.001). NT-proBNP and birth weight were negatively correlated (r= -0.323, p=0.005). NT-proBNP was found to be an individual determinant of low birth weight in univariate analysis (OR:1.03; 95%CI:1.01-1.04). CONCLUSION NT-proBNP levels can be useful to predict low birth weight in pregnancies with chronic HT.
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Affiliation(s)
- Mehmet Akif Erdol
- Department of Cardiology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Hasan Eroglu
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Gazi Antep Training and Research Hospital, Gazi Antep, Turkey
| | - Nazan Vanli Tonyali
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Mehmet Erdogan
- Department of Cardiology, Yildirim Beyazid University, Ankara City Hospital, Ankara, Turkey
| | - Aykan Yucel
- Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Nuray Yazihan
- Department of Pathophysiology, Ankara University, Faculty of Medicine, Internal Medicine, Pathophysiology Department, Ankara University, Institute of Health Sciences, Interdisciplinary Food, Metabolism and Clinical Nutrition Department, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Speckle Tracking Echocardiography in Hypertensive Pregnancy Disorders: A Systematic Review. Obstet Gynecol Surv 2021; 75:497-509. [PMID: 32856716 DOI: 10.1097/ogx.0000000000000811] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Hypertensive pregnancy disorders (HPDs) are associated with an increased risk of long-term cardiovascular disease. Speckle tracking echocardiography (STE) might be useful in the early detection of preclinical cardiac changes in women with HPDs. Objective The aim of this study was to study whether STE is a suitable method to detect differences in cardiac function in pregnant women with HPD compared with normotensive pregnant women or between women with a history of a pregnancy complicated by HPD compared with women with a history of an uncomplicated pregnancy. Evidence Acquisition The databases Medline, EMBASE, and Central were systematically searched for studies comparing cardiac function measured with STE in pregnant women with HPD or women with a history of HPD and women with a history of normotensive pregnancies. Results The search identified 16 studies, including 870 women with a history of HPD and 693 normotensive controls. Most studies during pregnancy (n = 12/13) found a decreased LV-GLS (left ventricular global longitudinal strain) in HPD compared with normotensive pregnant controls. LV-GRS (left ventricular global radial strain) and LV-GLCS (left ventricular global circumferential strain) are decreased in women with early-onset and severe preeclampsia. Women with a history of early-onset preeclampsia show lasting myocardial changes, with significantly decreased LV-GLS, LV-GLCS, and LV-GRS. Conclusions and Relevance LV-GLS is significantly decreased in pregnant women with HPD compared with normotensive pregnant women. Other deformation values show a significant decrease in women with severe or early-onset preeclampsia, with lasting myocardial changes after early-onset preeclampsia.
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Semmler J, Garcia-Gonzalez C, Sanchez Sierra A, Gallardo Arozena M, Nicolaides KH, Charakida M. Fetal cardiac function at 35-37 weeks' gestation in pregnancies that subsequently develop pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:417-422. [PMID: 33098138 DOI: 10.1002/uog.23521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare fetal cardiac morphology and function between pregnancies that subsequently developed pre-eclampsia (PE) and those that remained normotensive. METHODS This was a prospective observational study in 1574 pregnancies at 35-37 weeks' gestation, including 76 that subsequently developed PE. We carried out comprehensive assessment of fetal cardiac morphology and function including novel imaging modalities, such as speckle-tracking echocardiography, and measured uterine artery pulsatility index, mean arterial pressure (MAP), serum placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and cerebroplacental ratio (CPR). The findings in the group that subsequently developed PE were compared to those in pregnancies that remained normotensive. RESULTS In fetuses of mothers who subsequently developed PE, compared to those from normotensive pregnancies, there was a more globular right ventricle, as shown by reduced right ventricular sphericity index, reduced right ventricular systolic contractility, as shown by reduced global longitudinal strain, and reduced left ventricular diastolic function, as shown by increased E/A ratio. On multivariable regression analysis, these indices demonstrated an association with PE, independent of maternal characteristics and fetal size. In pregnancies that subsequently developed PE, compared to those that remained normotensive, MAP, sFlt-1 and the incidence of low birth weight were higher, whereas serum PlGF, CPR and the interval between assessment and delivery were lower. These findings demonstrate that, in pregnancies that develop PE, there is evidence of impaired placentation, reflected in low PlGF and reduced birth weight, placental ischemia, evidenced by increased sFlt-1 which becomes apparent in the interval of 2-4 weeks preceding the clinical onset of PE, and consequent fetal hypoxia-induced redistribution in the fetal circulation, reflected in the low CPR. CONCLUSION Although the etiology of the observed fetal cardiac changes in pregnancies that subsequently develop PE remains unclear, it is possible that the reduction in right-heart systolic function is the consequence of high afterload due to increased placental resistance, whilst the early left ventricular diastolic changes could be due to fetal hypoxia-induced redistribution in the fetal circulation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Semmler
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - C Garcia-Gonzalez
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Sanchez Sierra
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Gallardo Arozena
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Natori N, Oyama R, Baba T, Isurugi C, Chida H, Haba G, Sasaki Y, Kanasugi T, Itamochi H, Kikuchi A. Velocity vector imaging for evaluation of fetal vertical function throughout gestation. HYPERTENSION RESEARCH IN PREGNANCY 2019. [DOI: 10.14390/jsshp.hrp2019-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Noriko Natori
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Rie Oyama
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Chizuko Isurugi
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Hideyuki Chida
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
- Department of Obstetrics and Gynecology, Iwate Prefectural Ninohe Hospital
| | - Gen Haba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Yuri Sasaki
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Tomonobu Kanasugi
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
- Department of Obstetrics and Gynecology, Iwate Prefectural Ofunato Hospital
| | - Hiroaki Itamochi
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
| | - Akihiko Kikuchi
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine
- Center for Maternal, Fetal and Neonatal Medicine, Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University
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