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O'Driscoll JM, McCarthy FP, Giorgione V, Jalaludeen N, Seed PT, Gill C, Sparkes J, Poston L, Marber M, Shennan AH, Chappell LC, Thilaganathan B, Leeson P. Left Atrial Mechanics Following Preeclamptic Pregnancy. Hypertension 2024; 81:1644-1654. [PMID: 38757271 DOI: 10.1161/hypertensionaha.123.22577] [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: 12/12/2023] [Accepted: 05/05/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Preterm preeclampsia is a pregnancy complication associated with myocardial dysfunction and premature cardiovascular disease morbidity and mortality. Left atrial (LA) strain is a noninvasive index of left ventricular end diastolic pressure and an early marker of heart failure risk. This study aimed to evaluate LA strain during the postpartum period in participants with and without preterm preeclampsia and to assess whether this varied in the presence of hypertension, cardiac dysfunction or both. METHODS In this longitudinal cohort study, 321 women from 28 hospitals with preterm preeclampsia (cases) underwent cardiovascular assessment 6 months postpartum. This is a secondary analysis of the PHOEBE study (ISRCTN01879376). An uncomplicated pregnancy control group (n=30) was recruited from a single center for comparison. A full cross-sectional transthoracic echocardiogram was performed, and from these images, the myocardial strain of the left atrium, including reservoir, conduit, and contractile strain, as well as LA stiffness, were calculated. RESULTS At 6 months postpartum, compared with controls, prior preeclampsia was associated with a significantly attenuated LA reservoir, conduit, and contractile strain, as well as increased LA stiffness (all P<0.001). LA strain was further reduced in preeclamptic women who had and had not developed hypertension, systolic, or diastolic dysfunction at 6 months postpartum (all P<0.05). CONCLUSIONS LA mechanics were significantly attenuated at 6 months postpartum in participants with preterm preeclampsia, whether or not they remained hypertensive or had evidence of ventricular dysfunction. Further studies are needed to determine whether postnatal LA strain may identify women at greater risk for future cardiovascular disease.
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Affiliation(s)
- Jamie M O'Driscoll
- School of Psychology and Life Science, Canterbury Christ Church University, Kent, United Kingdom (J.M.O.D.)
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (J.M.O.D.)
| | - Fergus P McCarthy
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
- Department of Obstetrics and Gynaecology, The INFANT Research Centre, University College Cork, Cork University Maternity Hospital, Ireland (F.P.M.C.)
| | - Veronica Giorgione
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's University of London, United Kingdom (V.G., B.T.)
| | - Navazh Jalaludeen
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom (N.J.)
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Carolyn Gill
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Jenie Sparkes
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Mike Marber
- Cardiovascular Division, King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus, United Kingdom (M.M.)
| | - Andrew H Shennan
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, United Kingdom (F.P.M.C., P.T.S., C.G., J.S., L.P., A.H.S., L.C.C.)
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's University of London, United Kingdom (V.G., B.T.)
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, University of Oxford, United Kingdom (P.L.)
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Sonaglioni A, Pusca I, Casieri F, Dell'Anna R, Luigi Nicolosi G, Bianchi S, Lombardo M. Echocardiographic assessment of left atrial mechanics in women with hypertensive disorders of pregnancy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 299:62-70. [PMID: 38838388 DOI: 10.1016/j.ejogrb.2024.05.044] [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: 01/28/2024] [Revised: 04/27/2024] [Accepted: 05/31/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE The influence of hypertensive disorders of pregnancy (HDP) on left atrial (LA) mechanics assessed by speckle tracking echocardiography (STE) has been poorly investigated. Accordingly, we performed a meta-analysis to summarize the main findings of STE studies who measured LA reservoir (LASr), conduit (LAScd) and contractile (LASct) strain in HDP women. STUDY DESIGN All echocardiographic studies assessing LA strain parameters in HDP women vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LASr, LAScd and LASct) were pooled as standardized mean difference (SMD) comparing HDP group with healthy controls. The overall SMDs of LASr, LAScd and LASct were calculated using the random-effect model. RESULTS The full-texts of 8 studies with 566 HDP women and 420 healthy pregnant women were analyzed. Average LASr (34.3 ± 6.4 vs 42.7 ± 5.3 %, P = 0.01) and LAScd (23.4 ± 6.3 vs 32.5 ± 6.0 %, P < 0.001) were significantly lower in HDP women than controls, whereas LASct (-13.0 ± 5.4 vs -13.7 ± 4.5 %, P = 0.18) was similar in the two groups of women. Substantial heterogeneity was detected among the studies evaluating LASr (I2 = 94.3 %), LAScd (I2 = 64.9 %) and LASct (I2 = 86.4 %). SMDs were large and statistically significant for LASr (-1.70, 95 %CI -2.34,-1.06, P < 0.001) and LAScd (-1.35, 95 %CI -1.69,-1.00, P < 0.001), small and not statistically significant for LASct (-0.11, 95 %CI -0.60,0.39, P = 0.678) assessment. Egger's test gave P-values of 0.10, 0.34 and 0.75 for LASr, LAScd and LASct measurement respectively, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for LASr and its components (all P < 0.05). CONCLUSIONS HDPs are independently associated with LASr impairment in pregnancy. STE allows to identify, among HDP women, those who might benefit from a more aggressive antihypertensive treatment and/or a closer clinical follow-up, aimed at reducing the risk of adverse maternal outcome and cardiovascular complications later in life.
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Affiliation(s)
| | - Irene Pusca
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Federica Casieri
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Rebecca Dell'Anna
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | | | - Stefano Bianchi
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
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Kitt J, Krasner S, Barr L, Frost A, Tucker K, Bateman PA, Suriano K, Kenworthy Y, Lapidaire W, Lacharie M, Mills R, Roman C, Mackillop L, Cairns A, Aye C, Ferreira V, Piechnik S, Lukaschuk E, Thilaganathan B, Chappell LC, Lewandowski AJ, McManus RJ, Leeson P. Cardiac Remodeling After Hypertensive Pregnancy Following Physician-Optimized Blood Pressure Self-Management: The POP-HT Randomized Clinical Trial Imaging Substudy. Circulation 2024; 149:529-541. [PMID: 37950907 DOI: 10.1161/circulationaha.123.067597] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/09/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Hypertensive pregnancy disorders are associated with adverse cardiac remodeling, which can fail to reverse in the postpartum period in some women. The Physician-Optimized Postpartum Hypertension Treatment trial demonstrated that improved blood pressure control while the cardiovascular system recovers postpartum associates with persistently reduced blood pressure. We now report the effect on cardiac remodeling. METHODS In this prospective, randomized, open-label, blinded end point trial, in a single UK hospital, 220 women were randomly assigned 1:1 to self-monitoring with research physician-optimized antihypertensive titration or usual postnatal care from a primary care physician and midwife. Participants were 18 years of age or older, with preeclampsia or gestational hypertension, requiring antihypertensives on hospital discharge postnatally. Prespecified secondary cardiac imaging outcomes were recorded by echocardiography around delivery, and again at blood pressure primary outcome assessment, around 9 months postpartum, when cardiovascular magnetic resonance was also performed. RESULTS A total of 187 women (101 intervention; 86 usual care) underwent echocardiography at baseline and follow-up, at a mean 258±14.6 days postpartum, of which 174 (93 intervention; 81 usual care) also had cardiovascular magnetic resonance at follow-up. Relative wall thickness by echocardiography was 0.06 (95% CI, 0.07-0.05; P<0.001) lower in the intervention group between baseline and follow-up, and cardiovascular magnetic resonance at follow-up demonstrated a lower left ventricular mass (-6.37 g/m2; 95% CI, -7.99 to -4.74; P<0.001), end-diastolic volume (-3.87 mL/m2; 95% CI, -6.77 to -0.98; P=0.009), and end-systolic volume (-3.25 mL/m2; 95% CI, 4.87 to -1.63; P<0.001) and higher left and right ventricular ejection fraction by 2.6% (95% CI, 1.3-3.9; P<0.001) and 2.8% (95% CI, 1.4-4.1; P<0.001), respectively. Echocardiography-assessed left ventricular diastolic function demonstrated a mean difference in average E/E' of 0.52 (95% CI, -0.97 to -0.07; P=0.024) and a reduction in left atrial volumes of -4.33 mL/m2 (95% CI, -5.52 to -3.21; P<0.001) between baseline and follow-up when adjusted for baseline differences in measures. CONCLUSIONS Short-term postnatal optimization of blood pressure control after hypertensive pregnancy, through self-monitoring and physician-guided antihypertensive titration, associates with long-term changes in cardiovascular structure and function, in a pattern associated with more favorable cardiovascular outcomes. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04273854.
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Affiliation(s)
- Jamie Kitt
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Samuel Krasner
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Logan Barr
- Queen's University School of Medicine, Kingston, Canada (L.B.)
| | - Annabelle Frost
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
| | - Katherine Tucker
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Paul A Bateman
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Katie Suriano
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Yvonne Kenworthy
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Winok Lapidaire
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Miriam Lacharie
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.L., R.M., S.P.), University of Oxford, United Kingdom
| | - Rebecca Mills
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.L., R.M., S.P.), University of Oxford, United Kingdom
| | - Cristian Roman
- Institute of Biomedical Engineering, Department of Engineering Science (C.R.), University of Oxford, United Kingdom
| | - Lucy Mackillop
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
| | - Alexandra Cairns
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
| | - Christina Aye
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
- Fetal Medicine Unit, Oxford University Hospitals National Health Service Foundation Trust, United Kingdom (C.A.)
| | - Vanessa Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (V.F., E.L.), University of Oxford, United Kingdom
| | - Stefan Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.L., R.M., S.P.), University of Oxford, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (V.F., E.L.), University of Oxford, United Kingdom
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (B.T.)
- Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (B.T.)
| | - Lucy C Chappell
- King's College London and Guy's and St Thomas' National Health Service Foundation Trust, United Kingdom (L.C.C.)
| | - Adam J Lewandowski
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Paul Leeson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
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Birnie K, Catov J, Anderson EL, Lapidaire W, Kilpi F, Lawlor DA, Fraser A. Hypertensive disorders of pregnancy and midlife maternal cognition in a prospective cohort study. J Clin Hypertens (Greenwich) 2024; 26:166-176. [PMID: 38214209 PMCID: PMC10857467 DOI: 10.1111/jch.14765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024]
Abstract
Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disorders, with recent evidence linking pre-eclampsia with vascular dementia. We examined associations of HDP with cognitive performance measured in midlife, in a prospective cohort study, the Avon Longitudinal Study of Parents and Children. Six cognitive function domains were measured 20 years after pregnancy at a mean age of 51 years. The cognition tests were repeated at clinics in the following two years. Cognitive function domains measured were immediate and delayed verbal episodic memory, working memory, processing speed, verbal intelligence, and verbal fluency. Exposures were pre-eclampsia, gestational hypertension (GH), and a combined category of any HDP, all compared to normotensive pregnancy. Of 3393 pregnancies included in the analysis, GH was experienced by 417 (12.3%) and pre-eclampsia by 57 (1.7%). GH was associated with lower verbal episodic memory, in the delayed logic memory test (-0.16 SDs; 95% CI -0.30, -0.03; p = .015) and there was weak evidence of an association with the immediate logic memory test (-0.13 SDs; -0.27, 0.001; p = .058). However, we did not see steeper declines by age for women with GH and there was no evidence of associations with other cognitive domains or for pre-eclampsia with any domains. Results were not substantially changed after controlling for midlife blood pressure. Our findings suggest that a history of GH is associated with slightly reduced episodic memory 20 years after pregnancy, but we found no evidence of a quicker age-related decline compared to women with normotensive pregnancies.
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Affiliation(s)
- Kate Birnie
- Population Health Sciences, Bristol Medical SchoolBristolUK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield GroveBristolUK
| | - Janet Catov
- Department of Obstetrics and GynecologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Magee‐Womens Research InstitutePittsburghPennsylvaniaUSA
| | - Emma L. Anderson
- Population Health Sciences, Bristol Medical SchoolBristolUK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield GroveBristolUK
- Department of Mental Health of Older PeopleDivision of PsychiatryUniversity College LondonLondonUK
| | - Winok Lapidaire
- Division of Cardiovascular MedicineRadcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Fanny Kilpi
- Population Health Sciences, Bristol Medical SchoolBristolUK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield GroveBristolUK
| | - Deborah A. Lawlor
- Population Health Sciences, Bristol Medical SchoolBristolUK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield GroveBristolUK
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical SchoolBristolUK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield GroveBristolUK
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Giorgione V, Di Fabrizio C, Giallongo E, Khalil A, O'Driscoll J, Whitley G, Kennedy G, Murdoch CE, Thilaganathan B. Angiogenic markers and maternal echocardiographic indices in women with hypertensive disorders of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:206-213. [PMID: 37675647 DOI: 10.1002/uog.27474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE The maternal cardiovascular system of women with hypertensive disorders of pregnancy (HDP) can be impaired, with higher rates of left ventricular (LV) remodeling and diastolic dysfunction compared to those with normotensive pregnancy. The primary objective of this prospective study was to correlate cardiac indices obtained by transthoracic echocardiography (TTE) and circulating angiogenic markers, such as soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). METHODS In this study, 95 women with a pregnancy complicated by HDP and a group of 25 with an uncomplicated pregnancy at term underwent TTE and blood tests to measure sFlt-1 and PlGF during the peripartum period (before delivery or within a week of giving birth). Spearman's rank correlation was used to derive correlation coefficients between biomarkers and cardiac indices in the HDP and control populations. RESULTS The HDP group included 61 (64.2%) pre-eclamptic patients and, among them, 42 (68.9%) delivered before 37 weeks' gestation. Twelve women with HDP (12.6%) underwent blood sampling and TTE after delivery, and, as they showed significantly lower levels of angiogenic markers, they were excluded from the analysis. There was a correlation between sFlt-1 and LV mass index (LVMI) (r = 0.246; P = 0.026) and early diastolic mitral inflow velocity (E) and early diastolic mitral annular velocity (e') ratio (r = 0.272; P = 0.014) in the HDP group (n = 83), while in the controls, sFlt-1 showed a correlation with relative wall thickness (r = 0.409; P = 0.043), lateral e' (r = -0.562; P = 0.004) and E/e' ratio (r = 0.417; P = 0.042). PlGF correlated with LVMI (r = -0.238; P = 0.031) in HDP patients and with lateral e' (r = 0.466; P = 0.022) in controls. sFlt-1/PlGF ratio correlated with lateral e' (r = -0.568; P = 0.004) and E/e' ratio (r = 0.428; P = 0.037) in controls and with LVMI (r = 0.252; P = 0.022) and E/e' ratio (r = 0.269; P = 0.014) in HDP. CONCLUSIONS Although the current data are not able to infer causality, they confirm the intimate relationship between the maternal cardiovascular system and angiogenic markers that are used both to diagnose and indicate the severity of HDP. © 2023 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)
- V Giorgione
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - C Di Fabrizio
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - E Giallongo
- Intensive Care National Audit & Research Centre, London, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - J O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - G Whitley
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - G Kennedy
- Immunoassay Biomarker Core Laboratory, School of Medicine, University of Dundee, Dundee, UK
| | - C E Murdoch
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - B Thilaganathan
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
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Prameswari HS, Effendi CA, Khalid AF, Irianti S, Fatati I, Akbar MR. Relationship between serum soluble suppression of tumorigenicity (ST) 2 and global longitudinal strain in early onset preeclampsia. BMC Cardiovasc Disord 2024; 24:53. [PMID: 38229046 DOI: 10.1186/s12872-023-03696-9] [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: 06/28/2023] [Accepted: 12/26/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Preeclampsia is one of the leading causes of death in childbearing women worldwide. Hemodynamic changes in preeclampsia can trigger cardiac remodeling as indicated by increase of soluble-ST2 (sST2). Global longitudinal strain were able to detect systolic dysfunction better than the ejection fraction. This study aims to evaluate the correlation between serum levels of sST2 towards GLS in patients with early-onset preeclampsia. METHODS This is a cross-sectional observational study with correlation analysis. Subjects were patients with severe preeclampsia with gestational age before 34 weeks at Dr. Hasan Sadikin Central General Hospital Bandung and Bandung Kiwari Regional General Hospital from June to August 2022. Examination of sST2 was carried out through blood samples using the ELISA method. sST2 was measured using Presage ST2 Assay reagent. GLS examination was carried out using speckle tracking technique with EchoPAC. Correlation analysis was conducted using the Pearson test if normally distributed, otherwise Spearman's correlation was conducted. Correlation analysis was followed by linear regression. RESULTS A total of 30 patients met the inclusion criteria. The mean age was 30.83 ± 7.09, with 17 (56.7%) multiparous patients. The median sST2 was 145.75 ng/mL, and the median GLS was - 17.4%. Spearman correlation analysis showed that there was a significant positive correlation with moderate strength between sST2 and GLS (r = 0.583; p < 0.002). Linear regression showed that every 1 ng/ml increase in sST2 would give an increase in GLS of 0.014%. CONCLUSION There is a significant correlation between sST2 and GLS in patients with early onset severe preeclampsia.
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Affiliation(s)
- Hawani Sasmaya Prameswari
- Department of Cardiology and Vascular Medicine, Hasan Sadikin Central General Hospital, Universitas Padjadjaran, Bandung, West Java, Indonesia.
| | - Cut Azlina Effendi
- Department of Cardiology and Vascular Medicine, Hasan Sadikin Central General Hospital, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Achmad Fitrah Khalid
- Department of Cardiology and Vascular Medicine, Hasan Sadikin Central General Hospital, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Setyorini Irianti
- Department of Obsetrics and Gynecology, Hasan Sadikin Central General Hospital, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ita Fatati
- Department of Obsetrics and Gynecology, Kiwari Regional General Hospital, Bandung, West Java, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Hasan Sadikin Central General Hospital, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Simon E, Bechraoui-Quantin S, Tapia S, Cottenet J, Mariet AS, Cottin Y, Giroud M, Eicher JC, Thilaganathan B, Quantin C. Time to onset of cardiovascular and cerebrovascular outcomes after hypertensive disorders of pregnancy: a nationwide, population-based retrospective cohort study. Am J Obstet Gynecol 2023; 229:296.e1-296.e22. [PMID: 36935070 DOI: 10.1016/j.ajog.2023.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The increased maternal cardiocerebrovascular risk after a pregnancy complicated by hypertensive disorders of pregnancy, is well documented in the literature. Recent evidence has suggested a shorter timeframe for the development of these postnatal outcomes, which could have major clinical implications. OBJECTIVE This study aimed to determine the risk of and time to onset of maternal cardiovascular and cerebrovascular outcomes after a pregnancy complicated by hypertensive disorders of pregnancy. STUDY DESIGN This study included 2,227,711 women, without preexisting chronic hypertension, who delivered during the period 2008 to 2010: 37,043 (1.66%) were diagnosed with preeclampsia, 34,220 (1.54%) were diagnosed with gestational hypertension, and 2,156,448 had normotensive pregnancies. Hospitalizations for chronic hypertension, heart failure, coronary heart disease, cerebrovascular disease, and peripheral arterial disease were studied. A classical Cox regression was performed to estimate the average effect of hypertensive disorders of pregnancy over 10 years compared with normotensive pregnancy; moreover, an extended Cox regression was performed with a step function model to estimate the effect of the exposure variable in different time intervals: <1, 1 to 3, 3 to 5, and 5 to 10 years of follow-up. RESULTS The risk of chronic hypertension after a pregnancy complicated by preeclampsia was 18 times higher in the first year (adjusted hazard ratio, 18.531; 95% confidence interval, 16.520-20.787) to only 5 times higher at 5 to 10 years after birth (adjusted hazard ratio, 4.921; 95% confidence interval, 4.640-5.218). The corresponding risks of women with gestational hypertension were 12 times higher (adjusted hazard ratio, 11.727; 95% confidence interval, 10.257-13.409]) and 6 times higher (adjusted hazard ratio, 5.854; 95% confidence interval, 5.550-6.176), respectively. For other cardiovascular and cerebrovascular outcomes, there was also a significant effect with preeclampsia (heart failure: adjusted hazard ratio, 6.662 [95% confidence interval, 4.547-9.762]; coronary heart disease: adjusted hazard ratio, 3.083 [95% confidence interval, 1.626-5.844]; cerebrovascular disease: adjusted hazard ratio, 3.567 [95% confidence interval, 2.600-4.893]; peripheral arterial disease: adjusted hazard ratio, 4.802 [95% confidence interval, 2.072-11.132]) compared with gestational hypertension in the first year of follow-up. A dose-response effect was evident for the severity of preeclampsia with the averaged 10-year adjusted hazard ratios for developing chronic hypertension after early, preterm, and late preeclampsia being 10, 7, and 6 times higher, respectively. CONCLUSION The risks of cardiovascular and cerebrovascular outcomes were the highest in the first year after a birth complicated by hypertensive disorders of pregnancy. We found a significant relationship with both the severity of hypertensive disorders of pregnancy and the gestational age of onset suggesting a possible dose-response relationship for the development of cardiovascular and cerebrovascular outcomes. These findings call for an urgent focus on research into effective postnatal screening and cardiocerebrovascular risk prevention for women with hypertensive disorders of pregnancy.
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Affiliation(s)
- Emmanuel Simon
- Department of Gynecology, Obstetrics, and Fetal Medicine, University Hospital of Dijon, Dijon, France
| | - Sonia Bechraoui-Quantin
- Department of Gynecology, Obstetrics, and Fetal Medicine, University Hospital of Dijon, Dijon, France; Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France
| | - Solène Tapia
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France
| | - Jonathan Cottenet
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France
| | - Anne-Sophie Mariet
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France; Clinical Epidemiology and Clinical Trials Unit, Clinical Investigation Center, University Hospital of Dijon, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Hospital of Dijon, Dijon, France; Department of Pathophysiology and Epidemiology of Cerebrocardiovascular Diseases, University of Burgundy, Dijon, France; Registre des Infarctus du Myocarde de Côte d'Or, University Hospital of Dijon, Dijon, France
| | - Maurice Giroud
- Department of Neurology, University Hospital of Dijon, Dijon, France; Dijon Stroke Registry, Department of Pathophysiology and Epidemiology of Cerebrocardiovascular Diseases, University of Burgundy, Dijon, France
| | | | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Catherine Quantin
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France; Clinical Epidemiology and Clinical Trials Unit, Clinical Investigation Center, University Hospital of Dijon, Dijon, France; Center of Research in Epidemiology and Population Health, Université Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, National Institute of Health and Medical Research, Villejuif, France.
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8
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Giorgione V, Cauldwell M, Thilaganathan B. Pre-eclampsia and Cardiovascular Disease: From Pregnancy to Postpartum. Eur Cardiol 2023; 18:e42. [PMID: 37456771 PMCID: PMC10345941 DOI: 10.15420/ecr.2022.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/02/2022] [Indexed: 07/18/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP) complicate approximately 10% of pregnancies. In addition to multiorgan manifestations related to endothelial dysfunction, HDP confers an increased risk of cardiovascular disease during delivery hospitalisation, such as heart failure, pulmonary oedema, acute MI and cerebrovascular events. However, the cardiovascular legacy of HDP extends beyond birth since these women are significantly more likely to develop cardiovascular risk factors in the immediate postnatal period and major cardiovascular disease in the long term. The main mediator of cardiovascular disease in women with a history of HDP is chronic hypertension, followed by obesity, hypercholesterolaemia and diabetes. Therefore, optimising blood pressure levels from the immediate postpartum period until the first months postnatally could have beneficial effects on the development of hypertension and improve long-term cardiovascular health. Peripartum screening based on maternal demographic, and clinical and echocardiographic data could help clinicians identify women with HDP at highest risk of developing postpartum hypertension who would benefit from targeted primary cardiovascular prevention.
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Affiliation(s)
- Veronica Giorgione
- Molecular and Clinical Sciences Research Institute, St. George's University of LondonLondon, UK
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation TrustLondon, UK
| | - Matthew Cauldwell
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation TrustLondon, UK
| | - Basky Thilaganathan
- Molecular and Clinical Sciences Research Institute, St. George's University of LondonLondon, UK
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation TrustLondon, UK
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9
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Curtis SL, Belham M, Bennett S, James R, Harkness A, Gamlin W, Thilaganathan B, Giorgione V, Douglas H, Carroll A, Kitt J, Colebourn C, Ribeiro I, Fairbairn S, Augustine DX, Robinson S, Thorne SA. Transthoracic Echocardiographic Assessment of the Heart in Pregnancy-a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society. Echo Res Pract 2023; 10:7. [PMID: 37076874 PMCID: PMC10116662 DOI: 10.1186/s44156-023-00019-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
Pregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes which result in structural and functional adaptations in the cardiovascular system. An understanding of the myocardial adaptations is important for echocardiographers and clinicians undertaking or interpreting echocardiograms on pregnant and post-partum women. This guideline, on behalf of the British Society of Echocardiography and United Kingdom Maternal Cardiology Society, reviews the expected echocardiographic findings in normal pregnancy and in different cardiac disease states, as well as echocardiographic signs of decompensation. It aims to lay out a structure for echocardiographic scanning and surveillance during and after pregnancy as well as suggesting practical advice on scanning pregnant women.
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Affiliation(s)
- Stephanie L Curtis
- University Hospitals Bristol and Weston NHS Trust, Bristol Heart Institute, Marlborough Street, Bristol, BS2 8HW, UK.
| | - Mark Belham
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sadie Bennett
- University Hospitals of North Midlands, Stoke-On-Trent, UK
| | - Rachael James
- University Hospitals Sussex NHS FT, Brighton, UK
- United Kingdom's Maternal Cardiology Society, London, UK
| | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Essex, UK
| | - Wendy Gamlin
- North West Heart Centre, Wythenshawe Hospital, Manchester, UK
| | | | | | | | | | - Jamie Kitt
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Isabel Ribeiro
- University Hospitals Bristol and Weston NHS Trust, Bristol Heart Institute, Marlborough Street, Bristol, BS2 8HW, UK
| | - Sarah Fairbairn
- University Hospitals Bristol and Weston NHS Trust, Bristol Heart Institute, Marlborough Street, Bristol, BS2 8HW, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Sara A Thorne
- University Health Network Toronto, Toronto General Hospital & Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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10
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Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of death in women. Women with history of adverse pregnancy outcomes (APOs) have approximately two-fold risk of future CVD, but until recently the association with future heart failure (HF) was unclear. Here, we summarize evidence for associations of APOs with HF, potential underlying mechanisms, and future directions for clinical translation. RECENT FINDINGS Women with history of hypertensive disorders of pregnancy (HDPs) have roughly two-fold risk of future HF compared with other parous women even after accounting for interval development of coronary artery disease. The HDPs portend heightened risk of HF with both reduced and preserved ejection fraction. Gestational diabetes mellitus (GDM) and other APOs such as preterm delivery, small-for-gestational-age delivery, and placental abruption may also confer additional risk for HF development. Possible underlying mechanisms linking APOs to HF include shared upstream risk factors and genetics, accelerated development of cardiometabolic risk factors postpartum, persistent endothelial and microvascular dysfunction, and impaired natriuretic peptide signaling. SUMMARY History of APOs, including HDPs and GDM, confer increased risk for development of HF years after delivery. Further research is needed to define strategies to optimize prepregnancy and postpartum cardiovascular health toward HF prevention.
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11
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Bernhard R. Primary prevention of cardiovascular disease and complications in pregnancy, detect individual risk and start early! Eur J Prev Cardiol 2023; 30:zwad017. [PMID: 36680373 DOI: 10.1093/eurjpc/zwad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Rauch Bernhard
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Bremserstraße 79, D-67063 Ludwigshafen, Germany
- Zentrum für Ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
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12
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Poon LC, Nguyen-Hoang L, Smith GN, Bergman L, O'Brien P, Hod M, Okong P, Kapur A, Maxwell CV, McIntyre HD, Jacobsson B, Algurjia E, Hanson MA, Rosser ML, Ma RC, O'Reilly SL, Regan L, Adam S, Medina VP, McAuliffe FM. Hypertensive disorders of pregnancy and long-term cardiovascular health: FIGO Best Practice Advice. Int J Gynaecol Obstet 2023; 160 Suppl 1:22-34. [PMID: 36635079 DOI: 10.1002/ijgo.14540] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high-income countries and approximately 25% in low- and middle-income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long-term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.
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Affiliation(s)
- Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Long Nguyen-Hoang
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pius Okong
- Department of Obstetrics and Gynecology, St Francis Hospital Nsambya, Kampala City, Uganda
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Cynthia V Maxwell
- Maternal Fetal Medicine, Sinai Health and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harold David McIntyre
- Mater Health, University of Queensland, Mater Health Campus, South Brisbane, Queensland, Australia
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Esraa Algurjia
- The World Association of Trainees in Obstetrics & Gynecology, Paris, France.,Elwya Maternity Hospital, Baghdad, Iraq
| | - Mark A Hanson
- Institute of Developmental Sciences, University Hospital Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
| | - Sharleen L O'Reilly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | | | - Sumaiya Adam
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Virna P Medina
- Department of Obstetrics and Gynecology, Faculty of Health, Universidad del Valle, Clínica Imbanaco Quirón Salud, Universidad Libre, Cali, Colombia
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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13
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Briller JE. Echocardiographic Screening in Hypertensive Pregnancy Disorders. J Am Coll Cardiol 2022; 80:1477-1479. [DOI: 10.1016/j.jacc.2022.08.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023]
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14
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Giorgione V, Khalil A, O’Driscoll J, Thilaganathan B. Peripartum Screening for Postpartum Hypertension in Women With Hypertensive Disorders of Pregnancy. J Am Coll Cardiol 2022; 80:1465-1476. [DOI: 10.1016/j.jacc.2022.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 01/07/2023]
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15
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Kim H, Kim IC, Bae JG, Lee HJ, Park JH, Song JE. Association of ST2 Elevation in the Early Third Trimester with Heart Failure and Pre-Eclampsia in the Peripartum Period. J Womens Health (Larchmt) 2022; 31:1587-1595. [PMID: 35666698 DOI: 10.1089/jwh.2021.0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Although high-risk pregnancies are common in clinical practice, there are limited data on the association of soluble suppression of tumorigenicity 2 (ST2) with pregnancy-related complications. The rates of maternal complications, including heart failure (HF) during the peripartum period, were evaluated according to the ST2 level. Methods: A single-center retrospective cohort study included and stratified 259 women with high-risk pregnancies in their early third trimester according to the ST2 levels. The primary endpoint was the occurrence of peripartum HF based on symptoms, N-terminal pro-brain natriuretic peptide, or echocardiography associated with fluid retention. The secondary endpoints consisted of pre-eclampsia, silent pleural effusion, and pericardial effusion during the peripartum period. We performed a logistic model for the association between ST2 and maternal complications. Results: Of the 259 patients (mean age: 36.4 years, mean gestational duration: 31.6 weeks), advanced age ≥35 years and twin gestation were the most prevalent risk factors. Patients with ST2 ≥ 35 ng/mL showed enlarged cardiac chambers. Peripartum HF occurred in 2 (1.6%) out of 121 patients with ST2 < 35 ng/mL and in 47 (34%) out of 138 patients with ST2 ≥ 35 ng/mL. Those with ST2 ≥ 35 ng/mL were more likely to have the secondary endpoints (40.6% vs. 5.8%, p < 0.001). After adjustment, ST2 ≥ 35 ng/mL was associated with a six-fold occurrence of peripartum HF and a four-fold increase in the secondary endpoints. Conclusions: In women with high-risk pregnancies, peripartum HF and pre-eclampsia were not uncommon, and ST2 ≥ 35 ng/mL in the third trimester was independently related to maternal complications.
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Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.,Department of Cardiology, School of Medicine and Institute for Medical Science, Keimyung University, Daegu, Republic of Korea
| | - Jin-Gon Bae
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hee-Jeong Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jung-Ho Park
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin-Eun Song
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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