Função endotelial, perfusão uterina e fluxo central em gestações complicadas por Pré-Eclampsia

Brandão, Augusto Henriques Fulgêncio; Cabral, Marcelo Araújo; Leite, Henrique Vítor; Cabral, Antônio Carlos Vieira

doi:10.1590/s0066-782x2012005000087

Cited by 9 publications

(11 citation statements)

References 14 publications

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“…Existing reports of FMD in the third trimester of normotensive pregnancy show mixed results, however impaired FMD in preeclamptic pregnancies is well-described (29, 30). We did not see evidence of pregnancy-induced change in FMD, though FMD/SS decreased over time in both groups.…”

Section: Commentmentioning

confidence: 97%

Pregnancy induces persistent changes in vascular compliance in primiparous women

Morris¹,

Hale²,

Badger³

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective Pregnancy induces rapid, progressive and substantial changes to the cardiovascular system. The low recurrence risk of preeclampsia, despite familial predisposition, suggests an adaptation associated with pregnancy that attenuates risk for subsequent preeclampsia. We aimed to evaluate the persistent effect of pregnancy on maternal cardiovascular physiology. Study Design Forty-five healthy nulliparous women underwent baseline cardiovascular assessment preconception and repeated an average of 30 months later. After baseline evaluation, 17 women (Preg) conceived singleton pregnancies and all delivered at term. The remaining 28 women comprised the non-pregnant control group (NP). We measured mean arterial blood pressure (MAP), cardiac output (CO), plasma volume (PV), pulse wave velocity (PWV), uterine blood flow (UBF), and flow-mediated vasodilation (FMD) at each visit. Results There was a significant decrease in mean arterial pressure from the prepregnancy visit to postpartum in women with an interval pregnancy (prepregnancy: 85.3±1.8, postpartum: 80.5±1.8 mm Hg), with no change in NP subjects (visit 1: 80.3±1.4, visit 2: 82.8±1.4 mm Hg), (p = .002). Pulse wave velocity was significantly decreased in women with an interval pregnancy (prepregnancy: 2.73±0.05, postpartum: 2.49±0.05 m/s), as compared to those without an interval pregnancy (visit 1: 2.56±0.04, visit 2: 2.50±0.04 m/s), (p = .005). We did not observe a residual effect of pregnancy on cardiac output, plasma volume, uterine blood flow or flow-mediated vasodilation. Conclusion Our observations of decreased mean arterial pressure and reduced arterial stiffness following pregnancy suggest a significant favorable effect of pregnancy on maternal cardiovascular remodeling. These findings may represent a mechanism by which preeclampsia risk is reduced in subsequent pregnancies.

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Section: Commentmentioning

confidence: 97%

Pregnancy induces persistent changes in vascular compliance in primiparous women

Morris¹,

Hale²,

Badger³

et al. 2015

American Journal of Obstetrics and Gynecology

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“…These included studies in women with risk factors for preeclampsia [64], studies that combined low and high-risk women [54, 49, 74], and studies that compared low-risk women to high-risk women who subsequently developed preeclampsia [50, 51]. One small study observed a non-significant trend towards lower FMD in women who later developed preeclampsia [75].…”

Section: Fmd and Preeclampsiamentioning

confidence: 99%

Flow-Mediated Dilation: Can New Approaches Provide Greater Mechanistic Insight into Vascular Dysfunction in Preeclampsia and Other Diseases?

Weissgerber

2014

Curr Hypertens Rep

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Endothelial dysfunction is a key feature of preeclampsia, and may contribute to increased cardiovascular disease risk years after pregnancy. Flow-mediated dilation (FMD) is a non-invasive endothelial function test that predicts cardiovascular event risk. New protocols allow researchers to measure three components of the FMD response: FMD, low flow-mediated constriction and the shear stimulus. This review encourages researchers to think beyond “low FMD” by examining how these three components may provide additional insights into the mechanisms and location of vascular dysfunction. The review then examines what FMD studies reveal about vascular dysfunction in preeclampsia, while highlighting opportunities to gain greater mechanistic insight from new protocols. Studies using traditional protocols show that FMD is low in mid-pregnancy prior to preeclampsia, at diagnosis, and for three years post-partum. However, FMD returns to normal by ten years post-partum. Studies using new protocols are needed to gain more mechanistic insight.

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“…Based on data from a study developed at HC-UFMG ( 8 ) , a cut-off value of 6.5% was utilized for the FMD results, with any results below such value being considered as altered.…”

Section: Methodsmentioning

confidence: 99%

“…Contrary to poor placental perfusion, that is the most striking event in the physiopathology of early PE (clinical manifestations before 34 weeks of gestation) as compared with late PE (manifestations after 34 weeks), endothelial dysfunction is present in both PE forms ( 6 - 8 ) . Thus, the evaluation of the endothelium function would be clinically interesting to predict any form of PE.…”

Section: Introductionmentioning

confidence: 94%

“…By means of biophysical and biochemical methods it is possible to detect the endothelial injury before it generates noticeable symptoms ( 6 , 7 ) . As it has already been clinically demonstrated that such an event can be diagnosed before the clinical criteria for the diagnosis of PE are met, tests evaluating the endothelial function could be utilized as PE predictors ( 8 ) .…”

Section: Introductionmentioning

confidence: 99%

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Predição de pré-eclâmpsia em suas formas tardia e precoce pela dilatação fluxo-mediada da artéria braquial

et al. 2014

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ObjectiveTo assess the accuracy in the prediction of both early and late preeclampsia by flow-mediated dilation of the brachial artery (FMD), a biophysical marker for endothelial dysfunction.Materials and MethodsA total of 91 patients, considered at high risk for development of preeclampsia were submitted to brachial artery FMD between 24 and 28 weeks of gestation.ResultsNineteen out of the selected patients developed preeclampsia, 8 in its early form and 11 in the late form. With a cut-off value of 6.5%, the FMD sensitivity for early preeclampsia prediction was 75.0%, with specificity of 73.3%, positive predictive value (PPV) of 32.4% and negative predictive value (NPV) of 91.9%. For the prediction of late preeclampsia, sensitivity = 83.3%, specificity = 73.2%, PPV = 34.4% and NPV = 96.2% were observed. And for the prediction of all associated forms of preeclampsia, sensitivity = 84.2%, specificity = 73.6%, PPV = 45.7% and NPV = 94.6% were observed.ConclusionFMD of the brachial artery is a test with good accuracy in the prediction of both early and late preeclampsia, which may represent a positive impact on the follow-up of pregnant women at high risk for developing this syndrome.

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Função endotelial, perfusão uterina e fluxo central em gestações complicadas por Pré-Eclampsia

Cited by 9 publications

References 14 publications

Pregnancy induces persistent changes in vascular compliance in primiparous women

Pregnancy induces persistent changes in vascular compliance in primiparous women

Flow-Mediated Dilation: Can New Approaches Provide Greater Mechanistic Insight into Vascular Dysfunction in Preeclampsia and Other Diseases?

Predição de pré-eclâmpsia em suas formas tardia e precoce pela dilatação fluxo-mediada da artéria braquial

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