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Countouris ME, Catov JM, Zhu J, de Jong N, Brands J, Chen X, Parks WT, Berlacher KL, Gandley RE, Straub AC, Villanueva FS. Association of Hypertensive Disorders of Pregnancy With Coronary Microvascular Dysfunction 8 to 10 Years After Delivery. Circ Cardiovasc Imaging 2024; 17:e016561. [PMID: 38771901 PMCID: PMC11115371 DOI: 10.1161/circimaging.124.016561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/17/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with subsequent adverse cardiac remodeling and cardiovascular disease. The role of myocardial microvascular disease among individuals with HDP and left ventricular (LV) remodeling as a potential link to cardiovascular disease is unknown. We aimed to determine whether individuals with HDP history have coronary microvascular dysfunction measured by coronary flow reserve 8 to 10 years after delivery and whether microvascular dysfunction correlates with LV remodeling. METHODS Individuals with pregnancies delivered from 2008 to 2010 underwent burst-replenishment myocardial contrast echocardiography (2017-2020) to quantify myocardial perfusion at rest and during dobutamine stress. Video intensity versus time data were used to derive β, the rate of rise of video intensity, a correlate for myocardial blood flow. Coronary flow reserve was calculated as the ratio of β at peak stress to β at rest, averaged across LV myocardial regions of interest. RESULTS We studied 91 individuals (aged 38±6 and 9.1±0.9 years postdelivery) and 19 with a history of HDP. Individuals with coronary microvascular dysfunction (coronary flow reserve <2.0; n=13) had a higher proportion of HDP (46.2% versus 16.7%; P=0.026) and higher prepregnancy body mass index, baseline heart rate, and hemoglobin A1c compared with those without microvascular dysfunction. The association of coronary flow reserve and HDP was attenuated after adjusting for cardiometabolic factors (P=0.133). In exploratory subgroup analyses, individuals with both LV remodeling (relative wall thickness >0.42) and HDP (n=12) had the highest proportion of microvascular dysfunction (41.7% versus +HDP-LV remodeling [n=7] 14.3%; -HDP+LV remodeling [n=26] 7.7%; P=0.0498). CONCLUSIONS In this small study, HDP history is associated with coronary microvascular dysfunction 1 decade after delivery, findings that may, in part, be driven by metabolic factors including obesity and diabetes. Microvascular dysfunction may contribute to cardiovascular disease among individuals with a history of HDP.
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Affiliation(s)
- Malamo E Countouris
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (M.E.C., J.Z., X.C., K.L.B., A.C.S., F.S.V.)
| | - Janet M Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences (J.M.C., R.E.G.), University of Pittsburgh, PA
- Department of Epidemiology (J.M.C.), University of Pittsburgh, PA
| | - Jianhui Zhu
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (M.E.C., J.Z., X.C., K.L.B., A.C.S., F.S.V.)
| | - Nikki de Jong
- Division of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (N.d.J.)
| | - Judith Brands
- Department of Library, Information and Communication Technologies Services and Archive, Enschede, the Netherlands (J.B.)
| | - Xucai Chen
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (M.E.C., J.Z., X.C., K.L.B., A.C.S., F.S.V.)
| | - W Tony Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada (W.T.P.)
| | - Kathryn L Berlacher
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (M.E.C., J.Z., X.C., K.L.B., A.C.S., F.S.V.)
| | - Robin E Gandley
- Department of Obstetrics, Gynecology, and Reproductive Sciences (J.M.C., R.E.G.), University of Pittsburgh, PA
| | - Adam C Straub
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (M.E.C., J.Z., X.C., K.L.B., A.C.S., F.S.V.)
- Department of Pharmacology and Chemical Biology (A.C.S.), University of Pittsburgh, PA
| | - Flordeliza S Villanueva
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (M.E.C., J.Z., X.C., K.L.B., A.C.S., F.S.V.)
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Elkattawy O, Patel S, Montoya J, Sarfaraz K, Alabed S, Gobji O, Elkattawy S, Romero J, Shamoon F. The Impact of Congestive Heart Failure on Outcomes in Patients Hospitalized With Preeclampsia. Cureus 2024; 16:e56387. [PMID: 38633946 PMCID: PMC11022979 DOI: 10.7759/cureus.56387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION The purpose of this study was to determine the prevalence of congestive heart failure (CHF) among patients admitted with preeclampsia as well as to analyze the independent association of CHF with in-hospital outcomes among women with preeclampsia. METHODS Data were obtained from the National (Nationwide) Inpatient Sample (NIS) from January 2016 to December 2019. We assessed the independent association of CHF with outcomes in patients admitted with preeclampsia. Predictors of mortality in patients admitted with preeclampsia were also analyzed. RESULTS Women with preeclampsia in the United States between 2016 and 2019 were included in our analysis. A total of 256,010 cases were isolated, comprising 1150 patients with preeclampsia and CHF (0.45%). Multivariate analysis demonstrated that CHF in patients with preeclampsia was independently associated with several outcomes, among them cardiac arrest (adjusted OR (aOR) 4.635, p=0.004), ventricular tachycardia (aOR 17.487, p<0.001), pulmonary embolism (aOR 6.987, p<0.001), and eclampsia (aOR 2.503, p=0.011). Conversely, we found CHF to be protective against postpartum hemorrhage (aOR 0.665, p=0.003). Among the predictors of mortality in preeclampsia are age (aOR 1.062, p=0.022), Asian or Pacific Islander race (aOR 4.695, p=0.001), and CHF (aOR 25.457, p<0.001). Conclusions: In a large cohort of patients admitted with preeclampsia, we found the prevalence of CHF to be 0.45%. CHF was associated with several adverse outcomes as well as increased length of stay.
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Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Saahil Patel
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Javier Montoya
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Kanzah Sarfaraz
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sedra Alabed
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Omar Gobji
- Internal Medicine, New York Medical College, Valhalla, USA
| | - Sherif Elkattawy
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
| | - Jesus Romero
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, USA
| | - Fayez Shamoon
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
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Maselienė T, Struckutė E, Breivienė R, Ramašauskaitė D, Dženkevičiūtė V. The Importance of Inflammatory and Angiogenic Markers in the Evaluation of Early Cardiovascular Disease Risk in Women with Hypertensive Disorders of Pregnancy. J Cardiovasc Dev Dis 2023; 10:407. [PMID: 37887854 PMCID: PMC10607798 DOI: 10.3390/jcdd10100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Women with hypertensive disorders of pregnancy (HDP) have a significantly higher risk of developing cardiovascular diseases later in life. The stratification of this risk using biomarkers during pregnancy can help to identify these women and apply early prevention. OBJECTIVE We aimed to determine proinflammatory cytokines and angiogenic markers, echocardiographic parameter changes after delivery and predict early cardiovascular disease risk in women with arterial hypertension and its complications during pregnancy. METHODS We conducted a literature search using the PubMed database for the last ten years. A total of 17 articles were included to our study and full text reviewed. RESULTS Four out of six studies found higher postpartum Interleukin-6 (IL-6) levels in women with HDP. IL-6 correlated positively with waist circumference, body mass index, and triglycerides, and negatively with high density lipoproteins (HDL). Two out of four studies found higher postpartum tumor necrosis factor alpha (TNF-α) levels in women with HDP but later concentration equalizes. One out of eight studies found higher placental growth factor (PlGF) and two out of eight found more elevated soluble fms-like tyrosine kinase-1 (sFlt-1) in women with HDP. With decreasing PlGF and increasing sFlt-1, common carotid artery intima and media thickness, aortic root diameter, left atrial diameter, left ventricle mass, systolic, diastolic, and mean blood pressure increased, whereas HDL decreased. One out of four studies found higher sFlt-1/PlGF. CONCLUSION IL-6 remains significantly higher after delivery. Few studies found higher TNF-α, sFlt-1, PlGF and their ratio postpartum. All studies found a correlation between angiogenic factors, IL-6, and cardiovascular disease risk factors.
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Affiliation(s)
- Tatjana Maselienė
- Clinics of Internal and Family Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania
| | - Emilija Struckutė
- Clinics of Obstetrics and Gyneacology, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (E.S.); (R.B.); (D.R.)
| | - Rūta Breivienė
- Clinics of Obstetrics and Gyneacology, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (E.S.); (R.B.); (D.R.)
| | - Diana Ramašauskaitė
- Clinics of Obstetrics and Gyneacology, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (E.S.); (R.B.); (D.R.)
| | - Vilma Dženkevičiūtė
- Clinics of Cardiology, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania;
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Medjedovic E, Kurjak A, Stanojević M, Begic E. Pre-eclampsia and maternal health through the prism of low-income countries. J Perinat Med 2023; 51:261-268. [PMID: 36205639 DOI: 10.1515/jpm-2022-0437] [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] [Received: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022]
Abstract
Hypertensive syndrome in pregnancy complicates up to 15% of pregnancies, and preeclampsia (PE) occurs in about 3-10% of pregnant women. Inadequate prenatal care is associated with higher mortality from PE, possibly due to reduced monitoring, detection, and missed opportunities for early intervention. The imperative of the clinician's work is to monitor the symptoms and clinical signs of PE, and stratification of patients in relation to the risk of PE is essential. PE represents a multisystem inflammatory response, and the consequences can be expected in all organs. The question of the effect of PE on long-term maternal health is raised. The aim of the paper is to present the effect of PE on the patient's health through the prism of low-income countries.
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Affiliation(s)
- Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Department of Gynecology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Asim Kurjak
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Milan Stanojević
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia.,Neonatal Unit, Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
| | - Edin Begic
- Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina.,Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
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Mesenchymal Stem Cells Therapies on Fibrotic Heart Diseases. Int J Mol Sci 2021; 22:ijms22147447. [PMID: 34299066 PMCID: PMC8307175 DOI: 10.3390/ijms22147447] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
Stem cell therapy is a promising alternative approach to heart diseases. The most prevalent source of multipotent stem cells, usually called somatic or adult stem cells (mesenchymal stromal/stem cells, MSCs) used in clinical trials is bone marrow (BM-MSCs), adipose tissue (AT-MSCs), umbilical cord (UC-MSCs) and placenta. Therapeutic use of MSCs in cardiovascular diseases is based on the benefits in reducing cardiac fibrosis and inflammation that compose the cardiac remodeling responsible for the maintenance of normal function, something which may end up causing progressive and irreversible dysfunction. Many factors lead to cardiac fibrosis and failure, and an effective therapy is lacking to reverse or attenuate this condition. Different approaches have been shown to be promising in surpassing the poor survival of transplanted cells in cardiac tissue to provide cardioprotection and prevent cardiac remodeling. This review includes the description of pre-clinical and clinical investigation of the therapeutic potential of MSCs in improving ventricular dysfunction consequent to diverse cardiac diseases.
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