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Eghan P, Folson AA, Donkor A, Kokuro C, Amo Wiafe Y. Relationship between hypertensive disorders of pregnancy (HDP) and cardiac remodeling during pregnancy: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 298:108-115. [PMID: 38749071 DOI: 10.1016/j.ejogrb.2024.05.003] [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: 11/07/2023] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal morbidity and mortality. The primary objective of this study was to ascertain whether maternal cardiac remodeling is more prevalent in HDP than normotensive pregnancy and if significant change in aortic root size is involved. The secondary objective was to determine the types of cardiac remodeling often associated with HDP. METHODS A systematic search was conducted across four electronic databases, including Medline, PubMed, Cochrane and EMBASE. The reference lists of selected articles were also searched to ensure no relevant studies were missed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed in this systematic review. RESULTS Out of 5,278 articles identified by the search terms, 9 were eligible for inclusion in the meta-analysis. The investigation unveiled a greater prevalence of maternal cardiac remodeling in HDP than normotensive pregnancies. The commonest type of maternal cardiac remodeling in both HDP and normotensive pregnancies was eccentric left ventricular hypertrophy, followed by concentric left ventricular remodeling which was more specific to HDP. Notably, left atrial diameter was significantly increased in HDP than normotensive pregnancies, suggesting higher prevalence of diastolic dysfunction. Additionally, the aortic root dimension was significantly increased in HDP than normotensive pregnancies. CONCLUSION This study underscores the importance of monitoring cardiac health in pregnancy, particularly in those with hypertensive disorders, in order to mitigate potential complications and improve maternal outcomes. Finally, the risk of aortic dissection that may occur as a long-term effect of aortic root enlargement in women with history of HDP ought to be investigated in future studies.
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Affiliation(s)
- Philip Eghan
- Department of Radiology, University of Ghana Medical Centre, Accra, Ghana; Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aba A Folson
- Department of Internal Medicine and Therapeutics, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Andrew Donkor
- Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi Ghana
| | - Yaw Amo Wiafe
- Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Marek-Iannucci S, Oliveros E, Brailovsky Y, Pirlamarla P, Roman A, Rajapreyar IN. Natriuretic peptide biomarkers in the imminent development of preeclampsia. Front Cardiovasc Med 2023; 10:1203516. [PMID: 37554369 PMCID: PMC10405731 DOI: 10.3389/fcvm.2023.1203516] [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] [Received: 04/10/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
Preeclampsia is the most common cause of morbidity and mortality in pregnancy, the incidence being significantly higher in low-income countries with reduced access to health care. Women with preeclampsia are at a higher risk of developing cardiovascular disease with a poorer long-term outcome. Early recognition and treatment are key to improving short- and long-term outcomes. Approximately 3%-5% of pregnant women will develop preeclampsia, with potentially fatal outcomes. Despite ongoing research, the exact pathophysiologic mechanism behind its development remains unclear. In this brief report, we describe the potential role of natriuretic peptides as biomarkers in the imminent development of preeclampsia. In a retrospective manner, we analyzed changes in the left ventricular ejection fraction and left atrial volume and increases in natriuretic peptide in correlation with the development of preeclampsia. We found that three out of four patients developed a significant increase in natriuretic peptide, which correlated with the development of preeclampsia and/or peripartum cardiomyopathy. Significant increases in natriuretic peptides around the time of delivery might be a marker for the imminent development of preeclampsia. Close monitoring of natriuretic peptide levels in the peripartum period could give important insight into the imminent development of preeclampsia in high-risk patients. Close follow-up in specialized cardio-obstetric clinics is highly recommended.
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Affiliation(s)
- Stefanie Marek-Iannucci
- Advanced Heart Failure and Transplant Cardiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Estefania Oliveros
- Temple Heart and Vascular Institute, Temple University, Philadelphia, PA, United States
| | - Yevgeniy Brailovsky
- Advanced Heart Failure and Transplant Cardiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Preethi Pirlamarla
- Advanced Heart Failure and Transplant Cardiology, Mount Sinai Hospital, New York, NY, United States
| | - Amanda Roman
- Obstetrics and Gynecology, Maternal and Fetal Medicine, Thomas Jefferson University, Philadelphia, United States
| | - Indranee N. Rajapreyar
- Advanced Heart Failure and Transplant Cardiology, Thomas Jefferson University, Philadelphia, PA, United States
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Verma S, Malik S, Bansal S. Left ventricular function and N-terminal pro b-type natriuretic peptide levels in women with hypertensive disorders of pregnancy: A prospective observational study. Int J Gynaecol Obstet 2022; 159:764-770. [PMID: 35304737 DOI: 10.1002/ijgo.14182] [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: 10/24/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/07/2022]
Abstract
To evaluate left ventricular function and measure N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in women with hypertensive disorders of pregnancy (HDP) in comparison to normotensive women and correlate these with maternal and neonatal outcomes. This was a prospective observational case-control study from 2018 to 2020 in an Indian tertiary care hospital and included antenatal women beyond 20 weeks of pregnancy with 160 women with HDP as cases and 160 normotensive women as controls. Echocardiography was performed to assess left ventricular structure and function. Quantitative analysis of NT-proBNP levels was performed based on fluorescence immunochromatography. Women with HDP were observed to have a significant difference in the value of left ventricular structure and function (P < 0.001). Mild systolic dysfunction was found in 13 (8.1%) women in the HDP group 8 (20%) women with severe pre-eclampsia and 5 (33.3%) women with eclampsia). Significantly lower values of left ventricular ejection fraction and higher values of NT-proBNP were recorded in women with HDP who developed maternal complications and had adverse neonatal outcomes (P < 0.001). Echocardiography and NT-proBNP levels have been shown to have a significant role in women with severe forms of HDP to detect early signs of cardiac dysfunction.
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Affiliation(s)
- Shivani Verma
- Department of Obstetrics and Gynecology, Safdarjung Hospital, Delhi, India
| | - Sunita Malik
- Department of Obstetrics and Gynecology, Safdarjung Hospital, Delhi, India
| | - Sandeep Bansal
- Department of Cardiology, Safdarjung Hospital, Delhi, India
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Joubert LH, Doubell AF, Langenegger EJ, Herrey AS, Bergman L, Bergman K, Cluver C, Ackermann C, Herbst PG. Cardiac magnetic resonance imaging in preeclampsia complicated by pulmonary edema shows myocardial edema with normal left ventricular systolic function. Am J Obstet Gynecol 2022; 227:292.e1-292.e11. [PMID: 35283087 DOI: 10.1016/j.ajog.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/31/2022] [Accepted: 03/02/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Preeclampsia complicates approximately 5% of all pregnancies. When pulmonary edema occurs, it accounts for 50% of preeclampsia-related mortality. Currently, there is no consensus on the degree to which left ventricular systolic dysfunction contributes to the development of pulmonary edema. OBJECTIVE This study aimed to use cardiac magnetic resonance imaging to detect subtle changes in left ventricular systolic function and evidence of acute left ventricular dysfunction (through tissue characterization) in women with preeclampsia complicated by pulmonary edema compared with both preeclamptic and normotensive controls. STUDY DESIGN Cases were postpartum women aged ≥18 years presenting with preeclampsia complicated by pulmonary edema. Of note, 2 control groups were recruited: women with preeclampsia without pulmonary edema and women with normotensive pregnancies. All women underwent echocardiography and 1.5T cardiac magnetic resonance imaging with native T1 and T2 mapping. Gadolinium contrast was administered to cases only. Because of small sample sizes, a nonparametric test (Kruskal-Wallis) with pairwise posthoc analysis using Bonferroni correction was used to compare the differences between the groups. Cardiac magnetic resonance images were interpreted by 2 independent reporters. The intraclass correlation coefficient was calculated to assess interobserver reliability. RESULTS Here, 20 women with preeclampsia complicated by pulmonary edema, 13 women with preeclampsia (5 with severe features and 8 without severe features), and 6 normotensive controls were recruited. There was no difference in the baseline characteristics between groups apart from the expected differences in blood pressure. Left atrial sizes were similar across all groups. Women with preeclampsia complicated by pulmonary edema had increased left ventricular mass (P=.01) but had normal systolic function compared with the normotensive controls. Furthermore, they had elevated native T1 values (P=.025) and a trend toward elevated T2 values (P=.07) in the absence of late gadolinium enhancement consistent with myocardial edema. Moreover, myocardial edema was present in all women with eclampsia or hemolysis, elevated liver enzymes, and low platelet count. Women with preeclampsia without severe features had similar findings to the normotensive controls. All cardiac magnetic resonance imaging measurements showed a very high level of interobserver correlation. CONCLUSION This study focused on cardiac magnetic resonance imaging in women with preeclampsia complicated by pulmonary edema, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count. We have demonstrated normal systolic function with myocardial edema in women with preeclampsia with these severe features. These findings implicate an acute myocardial process as part of this clinical syndrome. The pathogenesis of myocardial edema and its relationship to pulmonary edema require further elucidation. With normal left atrial sizes, any hemodynamic component must be acute.
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Blood pressure as a risk factor for eclampsia and pulmonary oedema in pre-eclampsia. Pregnancy Hypertens 2021; 26:2-7. [PMID: 34392166 DOI: 10.1016/j.preghy.2021.07.241] [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: 02/03/2021] [Revised: 06/09/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We evaluated whether blood pressure and change in blood pressure measurements during pregnancy were associated with eclampsia or pulmonary oedema among women with pre-eclampsia. STUDY DESIGN Observational study of women with eclampsia, pre-eclampsia complicated by pulmonary oedema and pre-eclampsia without end-organ complications (pre-eclampsia controls) at a large referral center in Cape Town, South Africa. MAIN OUTCOME MEASURES Blood pressure measurements at presentation for antenatal care were compared to measurements after a diagnosis of pre-eclampsia. Mean blood pressures and changes in blood pressures were also calculated and compared between groups at different time points. A sub analysis including women who presented for antenatal care before 20 weeks of gestation was performed. RESULTS When diagnosed with pre-eclampsia, women with pulmonary oedema had increased systolic blood pressures and women with eclampsia had increased diastolic blood pressures compared to pre-eclampsia controls. There were no differences in blood pressure measurements in early pregnancy between women who later developed eclampsia or pulmonary oedema compared to pre-eclampsia controls. CONCLUSION Blood pressure measurements in early pregnancy do not seem useful as a risk factor for the development of eclampsia or pulmonary oedema among women diagnosed with pre-eclampsia. Increased systolic or diastolic pressure at diagnosis of pre-eclampsia may be useful as a risk factor for the development of pulmonary oedema or eclampsia. Further research is needed to confirm these findings.
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Gencheva D, Nikolov F, Uchikova E, Hristova K, Mihaylov R, Pencheva B. Cardiac Biomarkers in hypertensive disorders of pregnancy. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In recent years, biomarkers have taken a central place in the assessment of cardiovascular diseases – from prediction to management and prognosis. On the other hand, enough evidence exists to assume that hypertensive disorders of pregnancy share a certain connection with cardiovascular diseases – from common risk factors and underlying mechanisms to the presence of a higher risk for women for the development of a great number of cardiovascular diseases, such as arterial hypertension, coronary atherosclerosis, stroke, peripheral artery disease, venous thromboembolism, and even a higher cardiovascular mortality. The key to a better understanding of the unfavorable cardiovascular profile of women with a hypertensive disorder of pregnancy may lie in their assessment with biomarkers, typically used in the field of cardiology. In this review, we have included studies investigating the use of cardiovascular biomarkers during or after a hypertensive pregnancy, namely, natriuretic peptides, high-sensitivity cardiac troponins, growth/differentiation factor 15 (GDF15), soluble suppression of tumorigenicity-2 (sST2), and galectin-3.
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Gondek A, Jagodzińska A, Pietrzak B, Mamcarz A, Cudnoch-Jędrzejewska A. Relevance of the assessment of natriuretic peptide plasma concentrations in hypertensive pregnant women. Biomarkers 2020; 25:449-457. [PMID: 32693619 DOI: 10.1080/1354750x.2020.1795264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Assessment of the plasma concentrations of natriuretic peptides (NPs) is widely used to diagnose and evaluate the progression of cardiac failure, and their potential as markers of preeclampsia (PE) has been examined in recent years. It has been established that plasma concentrations of NPs do not change in the course of normal pregnancy. However, elevated levels of these peptides may have a prognostic value in patients with PE. This study presents information about the relevance of NPs assessment in the evaluation of physiological pregnancy, as well as in pregnancy complicated with arterial hypertension. The most commonly examined NPs is the N-terminal fragment of the brain natriuretic peptide (NT-proBNP), and it may be prognostic marker of PE and other complications of pregnancy.
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Affiliation(s)
- Agata Gondek
- Department of Methodology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Jagodzińska
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.,1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Bronisława Pietrzak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Cudnoch-Jędrzejewska
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
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Ortner CM, Krishnamoorthy V, Neethling E, Flint M, Swanevelder JL, Lombard C, Fawcus S, Dyer RA. Point-of-Care Ultrasound Abnormalities in Late-Onset Severe Preeclampsia: Prevalence and Association With Serum Albumin and Brain Natriuretic Peptide. Anesth Analg 2019; 128:1208-1216. [PMID: 31094790 DOI: 10.1213/ane.0000000000003759] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pilot studies applying point-of-care ultrasound (POCUS) in preeclampsia indicate the presence of pulmonary interstitial edema, cerebral edema, and cardiac dysfunction. Laboratory markers of oncotic pressure (albumin) and cardiac dysfunction (brain natriuretic peptide [BNP]) may be abnormal, but the clinical application remains unclear. We investigated the prevalence of pulmonary interstitial syndrome (PIS), cardiac dysfunction, and increased optic nerve sheath diameter (ONSD) in late-onset preeclampsia with severe features. The primary aim was to examine the association between PIS or ONSD and maternal serum albumin level. The secondary aims were to explore the association between cardiac dysfunction and PIS, ONSD, BNP, and serum albumin level and between POCUS-derived parameters and a suspicious or pathological cardiotocograph. METHODS Ninety-five women were enrolled in this prospective observational cohort study. A POCUS examination of lungs, heart, and ONSD was performed. PIS was defined as a bilateral B-line pattern on lung ultrasound and diastolic dysfunction according to an algorithm of the American Society of Echocardiography. ONSD >5.8 mm was interpreted as compatible with raised intracranial pressure (>20 mm Hg). Serum BNP and albumin levels were also measured. RESULTS PIS, diastolic dysfunction, systolic dysfunction, and raised left ventricular end-diastolic pressure (LVEDP) were present in 23 (24%), 31 (33%), 9 (10%), and 20 (25%) women, respectively. ONSD was increased in 27 (28%) women. Concerning the primary outcome, there was no association between albumin level and PIS (P = .4) or ONSD (P = .63). With respect to secondary outcomes, there was no association between albumin level and systolic dysfunction (P = .21) or raised LVEDP (P = .44). PIS was associated with diastolic dysfunction (P = .02) and raised LVEDP (P = .009; negative predictive value, 85%). BNP level was associated with systolic (P < .001) and diastolic dysfunction (P = .003) and LVEDP (P = .007). No association was found between POCUS abnormalities and a suspicious/pathological cardiotocograph (P = .07). CONCLUSIONS PIS, diastolic dysfunction, and increased ONSD were common in preeclampsia with severe features. Cardiac ultrasound abnormalities may be more useful than albumin levels in predicting PIS. The absence of PIS may exclude raised LVEDP. The further clinical relevance of PIS and raised ONSD remains to be established. BNP level was associated with cardiac ultrasound abnormalities. Although this study was not designed to directly influence clinical management, the findings suggest that POCUS may serve as a useful adjunct to clinical examination for the obstetric anesthesiologist managing these complex patients.
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Affiliation(s)
- Clemens M Ortner
- From the Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Elmari Neethling
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Margot Flint
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Justiaan L Swanevelder
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Susan Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Robert A Dyer
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
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Ghomian N, Vakilian F, Shahri B, Rostaminejad V, Khadem-Rezaiyan M. Can brain natriuretic peptide predict cardiovascular complications in severe preeclampsia? A case-control study. Int J Reprod Biomed 2019; 17. [PMID: 31435608 PMCID: PMC6686655 DOI: 10.18502/ijrm.v17i4.4552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/18/2018] [Accepted: 01/19/2019] [Indexed: 11/24/2022] Open
Abstract
Background Preeclampsia is one of the most common pregnancy complications, which is one of the major causes of fetal and maternal mortality. Objective To compare the serum Brain Natriuretic Peptide (BNP) level in patients with severe preeclampsia and normal pregnancy and investigate associated cardiovascular complications. Materials and Methods This case-control study was performed on 94 women with a singleton pregnancy (severe preeclampsia and normal pregnancy) at Imam Reza Hospital in Mashhad, Iran. The venous blood samples were collected to evaluate the serum BNP level. All patients were subjected to echocardiography performed by a single cardiologist. Results The mean pro-BNP levels were 480.36 ± 754.52 and 67.46 ± 106.24 pg/dL in the severe preeclampsia and normal pregnancy patients, respectively (p < 0.001). However, adjusted BNP for maternal and gestational age was not different in the two groups (ANCOVA, p = 0.69). Furthermore, the two study groups showed no
significant difference in terms of the cardiac parameters, including ejection fraction (EF), left ventricle end-diastolic and -systolic diameters (LVEDD and LVESD, respectively), tricuspid annular
plane systolic excursion (TAPSE), and ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em). However,
the serum BNP level showed a significant correlation with EF (r = -0.39, p = 0.008), TAPSE (r = -0.47, p = 0.001), and E/Em ratio (r = 0.48, p = 0.001) in patients with severe preeclampsia. Conclusion It seems that BNP can be used as a predictor for some of the main cardiac functional indices (i.e., E/Em, EF, and TAPSE) in severe preeclampsia patients.
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Affiliation(s)
- Nayereh Ghomian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farveh Vakilian
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahram Shahri
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vesam Rostaminejad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Department of Social Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Liang H, Vårtun Å, Flo K, Widnes C, Acharya G. Maternal cardiac function, uterine artery hemodynamics and natriuretic peptides at 22-24 weeks of gestation and subsequent development of hypertensive disorders of pregnancy. Acta Obstet Gynecol Scand 2019; 98:507-514. [PMID: 30586148 DOI: 10.1111/aogs.13525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Maternal cardiac dysfunction as well as abnormal uterine artery (UtA) Doppler are associated with hypertensive disorders of pregnancy (HDP), but their relation is unclear. We investigated the correlation between maternal cardiac function, UtA hemodynamics and natriuretic peptides, and explored differences between women who subsequently developed HDP and those who did not. MATERIAL AND METHODS This was a prospective cross-sectional cohort study of 347 pregnant women at 22-24 weeks. Maternal cardiac function and systemic hemodynamics were investigated at baseline and after 90 seconds of passive leg raising using impedance cardiography. Preload reserve was defined as percent change (Δ%) in stroke volume and cardiac output from baseline to passive leg raising. UtA hemodynamics was studied using Doppler ultrasonography. UtA blood flow, resistance and pulsatility index were calculated. Fasting venous blood samples were analyzed for natriuretic peptides (pro atrial natriuretic peptide [proANP], N-terminal pro brain natriuretic peptide [Nt-proBNP] and C-type natriuretic peptide [CNP]). The course and outcome of pregnancy were recorded. RESULTS At baseline, ProANP correlated significantly with cardiac output (r = -0.122; P = .023) and left cardiac work index (r = -0.112; P = .037), whereas Nt-ProBNP correlated significantly with acceleration index (r = .127; P = .018) and velocity index (r = -0.111; P = .039. CNP correlated significantly with UtA blood flow (r = .118; P = .028) and resistance (r = -0.112; P = .037) but not with UtA pulsatility index (r = .034; P = .523). None of the natriuretic peptides correlated with preload reserve. At 22-24 weeks, women who subsequently developed HDP had lower UtA blood flow (552 vs 692 mL/min; P = .028), higher UtA resistance (0.28 vs .17 mmHg/mL/min; P = .004) and higher mean UtA pulsatility index (1.12 vs .84; P < .001) compared with those who did not; however, the natriuretic peptide levels were similar in the two groups. Women developing HDP had a significantly higher increase in stroke volume and cardiac output and more reduction in systemic vascular resistance following passive leg raising compared with the reference group. Left cardiac work index, acceleration index and velocity index decreased following passive leg raising in the reference group but increased in women who later developed HDP. CONCLUSIONS ProANP correlated with cardiac output and cardiac work, Nt-proBNP with indices of cardiac contractility, and CNP with UtA blood flow and resistance. None of these natriuretic peptides measured at 22-24 weeks of gestation reflected cardiac preload reserve or predicted development of HDP.
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Affiliation(s)
- Huan Liang
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Obstetrics, and Gynecology, Hospital of Fudan University, Shanghai, China
| | - Åse Vårtun
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
| | - Kari Flo
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
| | - Christian Widnes
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
| | - Ganesh Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway.,Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Escouto DC, Green A, Kurlak L, Walker K, Loughna P, Chappell L, Broughton Pipkin F, Bramham K. Postpartum evaluation of cardiovascular disease risk for women with pregnancies complicated by hypertension. Pregnancy Hypertens 2018; 13:218-224. [DOI: 10.1016/j.preghy.2018.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/08/2018] [Accepted: 06/29/2018] [Indexed: 01/25/2023]
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Role of endogenous digitalis-like factors in the clinical manifestations of severe preeclampsia: a sytematic review. Clin Sci (Lond) 2018; 132:1215-1242. [PMID: 29930141 DOI: 10.1042/cs20171499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Endogenous digitalis-like factor(s), originally proposed as a vasoconstrictor natriuretic hormone, was discovered in fetal and neonatal blood accidentally because it cross-reacts with antidigoxin antibodies (ADAs). Early studies using immunoassays with ADA identified the digoxin-like immuno-reactive factor(s) (EDLF) in maternal blood as well, and suggested it originated in the feto-placental unit. Mammalian digoxin-like factors have recently been identified as at least two classes of steroid compounds, plant derived ouabain (O), and several toad derived bufodienolides, most prominent being marinobufagenin (MBG). A synthetic pathway for MBG has been identified in mammalian placental tissue. Elevated maternal and fetal EDLF, O and MBG have been demonstrated in preeclampsia (PE), and inhibition of red cell membrane sodium, potassium ATPase (Na, K ATPase (NKA)) by EDLF is reversed by ADA fragments (ADA-FAB). Accordingly, maternal administration of a commercial ADA-antibody fragment (FAB) was tested in several anecdotal cases of PE, and two, small randomized, prospective, double-blind clinical trials. In the first randomized trial, ADA-FAB was administered post-partum, in the second antepartum. In the post-partum trial, ADA-FAB reduced use of antihypertensive drugs. In the second trial, there was no effect of ADA-FAB on blood pressure, but the fall in maternal creatinine clearance (CrCl) was prevented. In a secondary analysis using the pre-treatment maternal level of circulating Na, K ATPase (NKA) inhibitory activity (NKAI), ADA-FAB reduced the incidence of pulmonary edema and, unexpectedly, that of severe neonatal intraventricular hemorrhage (IVH). The fall in CrCl in patients given placebo was proportional to the circulating level of NKAI. The implications of these findings on the pathophysiology of the clinical manifestations PE are discussed, and a new model of the respective roles of placenta derived anti-angiogenic (AAG) factors (AAGFs) and EDLF is proposed.
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Maack C. The cardiac re-AKT-ion to chronic volume overload. Eur J Heart Fail 2018; 18:372-4. [PMID: 27203475 DOI: 10.1002/ejhf.523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/17/2016] [Accepted: 02/21/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Christoph Maack
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421 Homburg/Saar, Germany
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14
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Soma-Pillay P, Louw MC, Adeyemo AO, Makin J, Pattinson RC. Cardiac diastolic function after recovery from pre-eclampsia. Cardiovasc J Afr 2017; 29:26-31. [PMID: 28906533 PMCID: PMC6002791 DOI: 10.5830/cvja-2017-031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/10/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pre-eclampsia is associated with significant changes to the cardiovascular system during pregnancy. Eccentric and concentric remodelling of the left ventricle occurs, resulting in impaired contractility and diastolic dysfunction. It is unclear whether these structural and functional changes resolve completely after delivery. AIMS The objective of the study was to determine cardiac diastolic function at delivery and one year post-partum in women with severe pre-eclampsia, and to determine possible future cardiovascular risk. METHODS This was a descriptive study performed at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. Ninety-six women with severe preeclampsia and 45 normotensive women with uncomplicated pregnancies were recruited during the delivery admission. Seventy-four (77.1%) women in the pre-eclamptic group were classified as a maternal near miss. Transthoracic Doppler echocardiography was performed at delivery and one year post-partum. RESULTS At one year post-partum, women with pre-eclampsia had a higher diastolic blood pressure (p = 0.001) and body mass index (p = 0.02) than women in the normotensive control group. Women with early onset pre-eclampsia requiring delivery prior to 34 weeks' gestation had an increased risk of diastolic dysfunction at one year post-partum (RR 3.41, 95% CI: 1.11-10.5, p = 0.04) and this was irrespective of whether the patient had chronic hypertension or not. CONCLUSION Women who develop early-onset pre-eclampsia requiring delivery before 34 weeks are at a significant risk of developing cardiac diastolic dysfunction one year after delivery compared to normotensive women with a history of a low-risk pregnancy.
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Affiliation(s)
- P Soma-Pillay
- Cardiac Obstetric Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa; South African Medical Research Council; Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
| | - M C Louw
- Department of Cardiology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - A O Adeyemo
- MediClinic Heart Hospital, Pretoria, South Africa
| | - J Makin
- South African Medical Research Council; Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - R C Pattinson
- South African Medical Research Council; Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
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15
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Echocardiographic Techniques of Deformation Imaging in the Evaluation of Maternal Cardiovascular System in Patients with Complicated Pregnancies. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4139635. [PMID: 28904957 PMCID: PMC5585628 DOI: 10.1155/2017/4139635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022]
Abstract
Cardiovascular diseases (CVD) represent the leading cause of maternal mortality and morbidity. Knowledge of CVD in women is constantly evolving and data are emerging that female-specific risk factors as complications of pregnancy are conditions associated with an increased risk for the long-term development of CVD. Echocardiography is a safe and effective imaging technique indicated in symptomatic or asymptomatic pregnant women with congenital heart diseases who require close monitoring of cardiac function. Deformation imaging is an echocardiographic technique used to assess myocardial function by measuring the actual deformation of the myocardium through the cardiac cycle. Speckle-tracking echocardiography (STE) is a two-dimensional (2D) technique which has been found to be more accurate than tissue Doppler to assess both left ventricular (LV) and right ventricular (RV) myocardial function. The use of 2D STE however might present some technical issues due to the tomographic nature of the technique and the motion in the three-dimensional space of the myocardial speckles. This has promoted the use of 3D STE to track the motion of the speckles in the 3D space. This review will focus on the clinical value of the new echocardiographic techniques of deformation imaging used to assess the maternal cardiovascular system in complicated pregnancies.
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16
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Verlohren S, Perschel FH, Thilaganathan B, Dröge LA, Henrich W, Busjahn A, Khalil A. Angiogenic Markers and Cardiovascular Indices in the Prediction of Hypertensive Disorders of Pregnancy. Hypertension 2017; 69:1192-1197. [DOI: 10.1161/hypertensionaha.117.09256] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/09/2017] [Accepted: 04/06/2017] [Indexed: 01/21/2023]
Abstract
Angiogenic and antiangiogenic factors have proven to be an accurate predictive means of preeclampsia. Echocardiographic studies have shown that women with preeclampsia exhibit significant cardiovascular strain, especially early-onset preeclampsia. The aim of this study is to determine preeclampsia risk with soluble fms-like tyrosin kinase 1/placental growth factor ratio, serum NT-proBNP (N-terminal pro B-type natriuretic peptide), and biophysical markers of cardiovascular function in a prospective case–control study. We examined a cohort of 110 pregnant women with uneventful pregnancy outcome (controls) and 129 with hypertensive pregnancy disorders, including 77 with preeclampsia and 52 with pregnancy-induced hypertension. Cardiac indices were obtained with a USCOM-1A monitor, and soluble fms-like tyrosin kinase 1, placental growth factor, and NT-proBNP were measured in serum samples on automated platforms. Logistic regression, as well as Cox proportional hazard analysis, was performed. There were significant contributions from all variables tested, except for heart rate, stroke volume index, and cardiac index to the prediction model. When testing accuracy of respective markers in combination (full model) versus individual markers (soluble fms-like tyrosin kinase 1/placental growth factor ratio and total peripheral resistance) was compared. The soluble fms-like tyrosin kinase 1/placental growth factor ratio and total peripheral resistance performed as good as the full model, except for hypertensive pregnancy disorders and pregnancy-induced hypertension, where the full model performed better. The additional assessment of biophysical and biochemical markers of cardiovascular strain in pregnancy increases the detection of the composite group of hypertensive pregnancy disorders, while not significantly improving detection of preeclampsia alone. This offers a more precise insight into the pathogenesis of the disease, as well as offering a window for intervention, possibly decreasing cardiovascular mortality in these women.
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Affiliation(s)
- Stefan Verlohren
- From the Departments of Obstetrics (S.V., L.A.D., W.H.) and Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry (F.H.P.), Charité Universitätsmedizin Berlin, Germany; Labor Berlin - Charité Vivantes GmbH, Germany (F.H.P.); Fetal Medicine Unit, St Georges University Hospital Foundation NHS Trust and St Georges University London, UK (B.T., A.K.); and HealthTwiSt GmbH, Berlin, Germany (A.B.)
| | - Frank H. Perschel
- From the Departments of Obstetrics (S.V., L.A.D., W.H.) and Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry (F.H.P.), Charité Universitätsmedizin Berlin, Germany; Labor Berlin - Charité Vivantes GmbH, Germany (F.H.P.); Fetal Medicine Unit, St Georges University Hospital Foundation NHS Trust and St Georges University London, UK (B.T., A.K.); and HealthTwiSt GmbH, Berlin, Germany (A.B.)
| | - Baskaran Thilaganathan
- From the Departments of Obstetrics (S.V., L.A.D., W.H.) and Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry (F.H.P.), Charité Universitätsmedizin Berlin, Germany; Labor Berlin - Charité Vivantes GmbH, Germany (F.H.P.); Fetal Medicine Unit, St Georges University Hospital Foundation NHS Trust and St Georges University London, UK (B.T., A.K.); and HealthTwiSt GmbH, Berlin, Germany (A.B.)
| | - Lisa Antonia Dröge
- From the Departments of Obstetrics (S.V., L.A.D., W.H.) and Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry (F.H.P.), Charité Universitätsmedizin Berlin, Germany; Labor Berlin - Charité Vivantes GmbH, Germany (F.H.P.); Fetal Medicine Unit, St Georges University Hospital Foundation NHS Trust and St Georges University London, UK (B.T., A.K.); and HealthTwiSt GmbH, Berlin, Germany (A.B.)
| | - Wolfgang Henrich
- From the Departments of Obstetrics (S.V., L.A.D., W.H.) and Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry (F.H.P.), Charité Universitätsmedizin Berlin, Germany; Labor Berlin - Charité Vivantes GmbH, Germany (F.H.P.); Fetal Medicine Unit, St Georges University Hospital Foundation NHS Trust and St Georges University London, UK (B.T., A.K.); and HealthTwiSt GmbH, Berlin, Germany (A.B.)
| | - Andreas Busjahn
- From the Departments of Obstetrics (S.V., L.A.D., W.H.) and Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry (F.H.P.), Charité Universitätsmedizin Berlin, Germany; Labor Berlin - Charité Vivantes GmbH, Germany (F.H.P.); Fetal Medicine Unit, St Georges University Hospital Foundation NHS Trust and St Georges University London, UK (B.T., A.K.); and HealthTwiSt GmbH, Berlin, Germany (A.B.)
| | - Asma Khalil
- From the Departments of Obstetrics (S.V., L.A.D., W.H.) and Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry (F.H.P.), Charité Universitätsmedizin Berlin, Germany; Labor Berlin - Charité Vivantes GmbH, Germany (F.H.P.); Fetal Medicine Unit, St Georges University Hospital Foundation NHS Trust and St Georges University London, UK (B.T., A.K.); and HealthTwiSt GmbH, Berlin, Germany (A.B.)
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17
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Alma LJ, Bokslag A, Maas AHEM, Franx A, Paulus WJ, de Groot CJM. Shared biomarkers between female diastolic heart failure and pre-eclampsia: a systematic review and meta-analysis. ESC Heart Fail 2017; 4:88-98. [PMID: 28451444 PMCID: PMC5396047 DOI: 10.1002/ehf2.12129] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/25/2016] [Accepted: 11/15/2016] [Indexed: 12/11/2022] Open
Abstract
Evidence accumulates for associations between hypertensive pregnancy disorders and increased cardiovascular risk later. The main goal of this study was to explore shared biomarkers representing common pathogenic pathways between heart failure with preserved ejection fraction (HFpEF) and pre‐eclampsia where these biomarkers might be potentially eligible for cardiovascular risk stratification in women after hypertensive pregnancy disorders. We sought for blood markers in women with diastolic dysfunction in a first literature search, and through a second search, we investigated whether these same biochemical markers were present in pre‐eclampsia.This systematic review and meta‐analysis presents two subsequent systematic searches in PubMed and EMBASE. Search I yielded 3014 studies on biomarkers discriminating women with HFpEF from female controls, of which 13 studies on 11 biochemical markers were included. Cases had HFpEF, and controls had no heart failure. The second search was for studies discriminating women with pre‐eclampsia from women with non‐hypertensive pregnancies with at least one of the biomarkers found in Search I. Search II yielded 1869 studies, of which 51 studies on seven biomarkers were included in meta‐analyses and 79 studies on 12 biomarkers in systematic review.Eleven biological markers differentiated women with diastolic dysfunction from controls, of which the following 10 markers differentiated women with pre‐eclampsia from controls as well: C‐reactive protein, HDL, insulin, fatty acid‐binding protein 4, brain natriuretic peptide, N terminal pro brain natriuretic peptide, adrenomedullin, mid‐region pro adrenomedullin, cardiac troponin I, and cancer antigen 125.Our study supports the hypothesis that HFpEF in women shares a common pathogenic background with pre‐eclampsia. The biomarkers representing inflammatory state, disturbances in myocardial function/structure, and unfavourable lipid metabolism may possibly be eligible for future prognostic tools.
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Affiliation(s)
- Lisa J Alma
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Anouk Bokslag
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Angela H E M Maas
- Department of CardiologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
| | - Arie Franx
- Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Walter J Paulus
- Department of PhysiologyVU University Medical CenterAmsterdamThe Netherlands
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Bhorat I, Naidoo DP, Moodley J. Maternal cardiac haemodynamics in severe pre-eclampsia complicated by acute pulmonary oedema: A review. J Matern Fetal Neonatal Med 2016; 30:2769-2777. [DOI: 10.1080/14767058.2016.1262842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- I. Bhorat
- Department of Obstetrics and Gynaecology, Subdepartment of Fetal Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - D. P. Naidoo
- Department of Cardiology, University of Kwa-Zulu Natal, Durban, South Africa
| | - J. Moodley
- Department of Obstetrics and Gynaecology and Women’s Health and HIV Research Group, University of Kwa-Zulu Natal, Durban, South Africa
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19
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Rangga Wibhuti IB, Soesanto AM, Shahab F. Diastolic function in patients with preeclampsia during pre- and post-partum period using tissue doppler imaging. MEDICAL JOURNAL OF INDONESIA 2016. [DOI: 10.13181/mji.v25i2.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Prior studies have compared the E/e’ elevation in preeclampsia patients to normal patients, however there are no data whether this elevation persists after birth. The aim of this study is to analyze diastolic function in preeclampsia patients during pre- and post-partum period using E/e’ parameter measurement.Methods: This is a prospective cohort study of pregnant women with preeclampsia who were hospitalized and planned for pregnancy termination. Basic clinical characteristics were obtained from all samples. Echocardiography was done prepartum, 48-72 hours after termination, and 40-60 days postpartum. Post hoc analysis using least significant difference method was used to compare the results between measurements.Results: 30 subjects were enrolled in the study. Analysis on E/e’ characteristics showed statistical difference between prepartum E/e’ and 40 days postpartum E/e’ (11.87±3.184 vs 9.43±2.529, p=0.001, CI=1.123-3.751), as well as between 48 hours post-partum and 40 days post-partum period (12.12±2.754 vs 9.43±2.529, p<0.001, CI=1.615-3.771). There were no statistical differences between pre-partum E/e’ and 48 hours post-partum E/e’ (11.87±3.184 vs 12.12±2.754, p=0.633, CI=-1.345-0.832).Conclusion: This study showed diastolic dysfunction in preeclampsia patients persists up until a few days after birth, but resolves in time (40 days after birth) as measured by tissue doppler imaging.
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Jain N, Verma A, Rajoria L. Evaluation of Echocardiographic Systolic Parameters in Pre-Eclamptics and Normotensives Women. J Obstet Gynaecol India 2016; 66:187-91. [PMID: 27651601 DOI: 10.1007/s13224-015-0823-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Early detection of changes in cardiovascular echocardiographic systolic parameters and their comparison with normotensives women. METHODS This was a hospital-based prospective case-control study carried out in Department of Obstetrics and Gynaecology in S.M.S Medical College, Jaipur, during the period from February 2013 to December 2014. In total, 100 women were enrolled in the study after applying inclusion and exclusion criteria. All women underwent two-dimensional echocardiography at rest. Cardiac systolic parameters were recorded and studied. RESULTS Mean LVEDV in the PIH group was 75.71 ± 4.8 versus 71.08 ± 5.6 ml in the control group, and the difference was statistically significant. Mean stroke volume was higher in the PIH group as compared to the control group, and the difference was statistically significant (59.83 ± 7.4 vs. 52.48 ± 6.4 ml/min). Mean aortic root diameter in the PIH group was 2.188 ± 1.04 cm as compared to the 1.866 ± 1.06 cm in the control group which was statistically significant. Mean left ventricular outflow tract diameter was slightly higher in the PIH group as compared to the controls although the P value was not significant (2.37 ± 1.06 and 1.99 ± 1.08 cm). Mean total vascular resistance was found to be higher in the PIH group as compared to the controls, and the difference was statistically significant (1389 ± 57.04 vs. 1286 ± 45.01 dynes/sec/cm(-5)). CONCLUSION Systolic parameters get worsened in pre-eclamptics. Early detection of change in these parameters could help to identify high-risk women who are prone to develop cardiovascular morbidity in later life.
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Affiliation(s)
- Neha Jain
- Department of Obstetrics and Gynaecology, S.M.S Medical College, Jaipur, Rajasthan India ; C 37 A Shanti Bhawan Harinagar, Near Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Asha Verma
- Department of Obstetrics and Gynaecology, S.M.S Medical College, Jaipur, Rajasthan India
| | - Lata Rajoria
- Department of Obstetrics and Gynaecology, S.M.S Medical College, Jaipur, Rajasthan India
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