Abstract-Preeclampsia is associated with asymptomatic global left ventricular abnormal function and geometry during the acute phase of the disorder. These subclinical abnormalities in cardiac findings are known to be important in cardiovascular risk stratification for nonpregnant patients. Furthermore, epidemiological studies have also demonstrated a relationship between preeclampsia and cardiac morbidity and mortality later in life. The aim of this study was to evaluate the postpartum natural history and clinical significance of asymptomatic left ventricular impairment known to occur with acute preeclampsia. This was a prospective longitudinal case-control study of 64 subjects with preeclampsia and 78 matched controls. There were 3 time point assessments, pregnancy and 1 and 2 years postpartum. The assessments included a medical and family history, blood pressure profile, echocardiography, and 12-lead ECG. At 1 year postpartum, asymptomatic left ventricular moderate-severe dysfunction/hypertrophy was significantly higher in preterm preeclampsia (56%) compared with term preeclampsia (14%) or matched controls (8%; P values Ͻ0.001). The risk of developing essential hypertension within 2 years was significantly higher in both preterm preeclamptic women and those with persistent left ventricular moderate-severe abnormal function/geometry. The cardiovascular implications of preeclampsia do not end with the birth of the infant and placenta. The majority of preterm preeclamptic women have stage B asymptomatic heart failure postpartum, and 40% develop essential hypertension within 1 to 2 years after pregnancy. Women with a history of preterm preeclampsia may benefit from formal cardiovascular risk assessment in the 1 to 2 years after delivery to identify those who would benefit from targeted therapeutic intervention. (Hypertension. 2011;58:709-715.)Key Words: preeclampsia Ⅲ remodeling Ⅲ heart failure Ⅲ echocardiography Ⅲ hypertension Ⅲ tissue Doppler Ⅲ strain rate A cute preeclampsia is associated with significantly higher prevalence of asymptomatic global left ventricular (LV) abnormal function/geometry and myocardial injury than uneventful pregnancy. 1 Preeclampsia is also associated with significantly higher risk of subsequent heart failure, ischemic and hypertensive heart diseases, and related mortality compared with uneventful pregnancy. 2,3 There is an increasing understanding that cardiovascular diseases are generally progressive disorders that proceed through asymptomatic to symptomatic stages. 4 -6 One of the principal manifestations of this progression is the change in the geometry and function of the left ventricle. 4 -6 Therapeutic intervention during the asymptomatic phase of cardiac impairment can improve the long-term prognosis more effectively than when commenced at a symptomatic stage. 4 -6 Notwithstanding these recent insights, there is a paucity of studies that assess postnatal cardiac chamber function/geometry and myocardial status in asymptomatic women who have had a pregnancy complicated by pree...

Abstract-Preeclampsia is a disease associated with significant cardiovascular morbidity during pregnancy and in later life.This study was designed to evaluate cardiac function and remodeling in preeclampsia occurring at term. This was a prospective case-control study of 50 term preeclampsia and 50 normal pregnancies assessed by echocardiography and tissue Doppler analysis. Global diastolic dysfunction was observed more frequently in preeclampsia versus control pregnancies (40% versus 14%, Pϭ0.007). Increased cardiac work and left ventricular mass indices suggest that left ventricular remodeling was an adaptive response to maintain myocardial contractility with preeclampsia at term. Approximately 20% of patients with preeclampsia at term have more evident myocardial damage. Diastolic dysfunction usually precedes systolic dysfunction in the evolution of ischemic or hypertensive cardiac diseases and is of prognostic value in the prediction of long-term cardiovascular morbidity. The study findings also have significant implications for the acute medical management of preeclampsia. (Hypertension. 2011;57:85-93.) • Online Data Supplement Key Words: diastolic dysfunction Ⅲ echocardiography Ⅲ left ventricular remodeling Ⅲ preeclampsia Ⅲ pregnancy Ⅲ strain rate Ⅲ tissue Doppler P reeclampsia (PE) is a pregnancy complication of placental etiology with acute onset of predominantly cardiovascular manifestations. 1 The pathological changes in this disorder are primarily ischemic in nature and are known to affect the placenta, kidney, liver, and brain, whereas there is scant and conflicting information about the impact on the heart. [1][2][3][4][5][6][7] Cardiopulmonary morbidity is seen in a significant proportion of preeclamptic cases 8 and autopsy data have demonstrated that preeclamptic women have a 10-fold higher prevalence of myocardial contraction band necrosis than deaths in pregnancy from other causes. 9 Epidemiological data have also highlighted the strong relationship between preeclampsia and premature morbidity and mortality from cardiovascular disease 10,11 thought to be related to shared cardiovascular risk factors. 12 All these data suggest that preeclampsia may be associated with the potential for significant myocardial damage. Tissue Doppler (TD) velocity and deformation indices are highly sensitive at detecting even mild myocardial damage. [13][14][15][16][17][18] The aim of this study is to test the hypothesis that PE provokes significant myocardial damage/dysfunction by using both conventional echocardiography and TD analysis in women with and without PE. Methods Study SubjectsThis was a prospective case-control study carried out over a 2-year period from January 2008. All women with singleton pregnancy and PE at term (37 to 42 completed weeks of gestation) were recruited consecutively as cases after informed consent and with local institutional review committee approval. Only women without comorbidities, nonsmokers, and before starting any medication were asked to take part in the study. PE and nonprotein...

In this Review we aim to provide up-to-date and evidencebased answers to the common questions regarding the diagnosis of isolated mild fetal ventriculomegaly (VM

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Asymptomatic cardiac diastolic dysfunction is evident at mid-gestation in women who subsequently develop preterm PE but not in those who develop term PE. These cardiac findings are useful in understanding the pathophysiology of PE and corroborate the concept that PE is not a single disorder, but a cluster of symptoms that have several different aetiologies.

The major limitation of earlier studies on left ventricular systolic function is the use of ejection-phase indices that are dependent on loading conditions. Even when tissue Doppler velocity and deformation indices were measured, studies interpreted diastolic indices in isolation, rather than using validated diagnostic algorithms which account for the interdependency of cardiac events. Furthermore, the strong age-dependency of diastolic function indices was not accounted for in the majority of assessments and none of the studies diagnose or grade diastolic dysfunction. Future studies should aim to use appropriate control individuals, age-adjusted cutoff of cardiac diastolic indices and extended tissue Doppler velocity and deformation indices to provide objective information about chamber and myocardial function.

Objectives To assess the relationship between firsttrimester uterine artery Doppler measurements and the development of term and preterm pre-eclampsia. Methods (P = 0.25; AUC, 0.54; 95% CI,

Women with preterm preeclampsia have a more severe cardiac impairment than those with term preeclampsia. This finding may explain the increased long-term cardiovascular risk associated with preterm preeclampsia. The cardiac assessment of women with preterm preeclampsia may be of relevance in identifying women at higher risk of developing cardiovascular morbidity and mortality in later life.