Cardiac maladaptation in term pregnancies with preeclampsia

Buddeberg, B; Sharma, Rajan; O’Driscoll, Jamie M; Agten, Andrea Kaelin; Khalil, Asma; Thilaganathan, B.

doi:10.1016/j.preghy.2018.06.015

Cited by 40 publications

(47 citation statements)

References 27 publications

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“…In contrast, very little is known about the impact of short-term hyperglycemia on the heart in women with GDM. There is a lack of prospective studies examining how GDM influences maternal cardiac adaptation to the increasing cardiovascular demands of pregnancy [8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Impact of gestational diabetes mellitus on maternal cardiac adaptation to pregnancy

Buddeberg

Sharma

O’Driscoll

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To determine whether maternal cardiac adaptation at term differs between women with, and those without, gestational diabetes mellitus (GDM). Methods This was a prospective case–control study of pregnant women at term with or without GDM. For both cases and controls, only women without any comorbidity or form of pre‐existing diabetes who had a singleton pregnancy without complication (such as pre‐eclampsia or fetal growth restriction) were included. All women underwent conventional and speckle‐tracking echocardiography to assess both the left‐ and right‐heart geometry and function. Results A total of 40 women with GDM and 40 healthy controls were enrolled. Women with GDM, compared with controls, had a significantly higher heart rate (83 ± 10 vs 75 ± 9 beats per min; P < 0.001), left ventricular (LV) relative wall thickness (0.43 ± 0.07 vs 0.37 ± 0.08; P < 0.001), LV early diastolic transmitral valve velocity (E) (0.80 ± 0.15 vs 0.73 ± 0.12 m/s; P = 0.026) and LV late diastolic transmitral valve velocity (A) (0.65 ± 0.13 vs 0.57 ± 0.11 m/s; P = 0.006). In women with GDM compared with controls, speckle‐tracking analysis revealed a significant reduction in LV global longitudinal strain (GLS) (−16.29 ± 2.26 vs −17.61 ± 1.89; P = 0.012), LV endocardial GLS (−18.50 ± 2.59 vs −19.84 ± 2.35; P = 0.031) and LV epicardial GLS (−14.40 ± 2.01 vs −15.73 ± 1.66; P = 0.005). Right ventricular (RV) analysis revealed a reduced pulmonary acceleration time (58 ± 10 vs 66 ± 11 ms; P = 0.001) and RV E/A ratio (1.13 ± 0.18 vs 1.29 ± 0.35; P = 0.017), as well as a higher RV myocardial systolic annular velocity (0.16 ± 0.04 vs 0.14 ± 0.02; P = 0.023) and peak late diastolic transtricuspid valve velocity (0.46 ± 0.1 m/s vs 0.39 ± 0.08 m/s; P = 0.001), in women with GDM compared to controls. Conclusions Our findings show that even a short period of exposure to hyperglycemia, as occcurs in women with GDM, is associated with significant maternal functional cardiac impairment at term. Given these findings, further study of postnatal maternal cardiovascular recovery after GDM pregnancy is warranted. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Introductionmentioning

confidence: 99%

Impact of gestational diabetes mellitus on maternal cardiac adaptation to pregnancy

Buddeberg

Sharma

O’Driscoll

et al. 2020

Ultrasound in Obstet & Gyne

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“…Indexing cardiac output may be an approximating process but provides a better understanding of the underlying pathophysiology, which demonstrates that early preeclampsia is characterised by lower maternal cardiac output, while late preeclampsia is associated with normal or lowered cardiac output compared to normal controls (Buddeberg et al . ; Gyselaers et al . ).…”

Section: Cardiovascular and Renal Characteristics Of Preeclampsiamentioning

confidence: 99%

“…; Buddeberg et al . ,b). It is still to be elucidated whether maternal endothelium dysfunction prior to conception is a prerequisite for development of preeclampsia, or whether sometimes this complication results from an imbalanced mother‐conceptus communication during implantation, a process involving numerous cellular, molecular and biochemical mechanisms such as angiogenetic factors (Boeldt & Bird, ; Nejabati et al .…”

Section: Cardiorenal Interactions In the Pathophysiology Of Preeclampsiamentioning

confidence: 99%

“…The indexing of cardiac output is limited by the fact that body surface area may not accurately reflect the metabolic demands of increased body mass, but at present no other method of indexing is available and such indexing remains the best way of understanding whether cardiac output is appropriate for maternal body size in pregnancy. Indexing cardiac output may be an approximating process but provides a better understanding of the underlying pathophysiology, which demonstrates that early preeclampsia is characterised by lower maternal cardiac output, while late preeclampsia is associated with normal or lowered cardiac output compared to normal controls (Buddeberg et al 2018a;Gyselaers et al 2019). The severity and temporal nature of cardiovascular dysfunction in early and late preeclampsia provides important insights into the pathophysiology of the disorder.…”

Section: Cardiorenal Interactions and Their Effect On Placental Permentioning

confidence: 99%

“…In the second trimester, echocardiographic abnormalities are already present (Valensise et al 2008a,b), but diastolic dysfunction is observed in early, but not late preeclampsia (Melchiorre et al 2016) -suggesting that diastolic dysfunction of late preeclampsia develops during the second half of pregnancy as a consequence of chronic volume overload (Valensise et al 2008a,b;Melchiorre et al 2016). Importantly, in both early-and late-onset preeclampsia, cardiac morphological changes such as adverse ventricular remodelling and increase in left ventricular mass precede the onset of chamber dysfunction (Cong et al 2015), and are not only restricted to the left side but also present in the right ventricle (Ç aglar et al 2016;Buddeberg et al 2018a).…”

Section: Cardiorenal Interactions and Their Effect On Placental Permentioning

confidence: 99%

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Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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It is generally accepted today that there are two different types of preeclampsia: an early‐onset or placental type and a late‐onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early‐ than in late‐onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation‐induced worsening of subclinical pre‐existing chronic cardiovascular dysfunction in early‐onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late‐onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.

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Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

Falcão‐Pires,

Ferreira,

Trindade

et al. 2024

European J of Heart Fail

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Cardiovascular disease (CVD) is the leading cause of morbimortality in Europe and worldwide. CVD imposes a heterogeneous spectrum of cardiac remodelling, depending on the insult nature, that is, pressure or volume overload, ischaemia, arrhythmias, infection, pathogenic gene variant, or cardiotoxicity. Moreover, the progression of CVD‐induced remodelling is influenced by sex, age, genetic background and comorbidities, impacting patients' outcomes and prognosis. Cardiac reverse remodelling (RR) is defined as any normative improvement in cardiac geometry and function, driven by therapeutic interventions and rarely occurring spontaneously. While RR is the outcome desired for most CVD treatments, they often only slow/halt its progression or modify risk factors, calling for novel and more timely RR approaches. Interventions triggering RR depend on the myocardial insult and include drugs (renin–angiotensin–aldosterone system inhibitors, beta‐blockers, diuretics and sodium–glucose cotransporter 2 inhibitors), devices (cardiac resynchronization therapy, ventricular assist devices), surgeries (valve replacement, coronary artery bypass graft), or physiological responses (deconditioning, postpartum). Subsequently, cardiac RR is inferred from the degree of normalization of left ventricular mass, ejection fraction and end‐diastolic/end‐systolic volumes, whose extent often correlates with patients' prognosis. However, strategies aimed at achieving sustained cardiac improvement, predictive models assessing the extent of RR, or even clinical endpoints that allow for distinguishing complete from incomplete RR or adverse remodelling objectively, remain limited and controversial. This scientific statement aims to define RR, clarify its underlying (patho)physiologic mechanisms and address (non)pharmacological options and promising strategies to promote RR, focusing on the left heart. We highlight the predictors of the extent of RR and review the prognostic significance/impact of incomplete RR/adverse remodelling. Lastly, we present an overview of RR animal models and potential future strategies under pre‐clinical evaluation.

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Cardiac maladaptation in term pregnancies with preeclampsia

Abstract: The findings of this study demonstrate that pregnant women with term preeclampsia with minimal functional changes on conventional echocardiography, demonstrated significant subclinical myocardial changes on speckle tracking analysis.

Cited by 40 publications

References 27 publications

Impact of gestational diabetes mellitus on maternal cardiac adaptation to pregnancy

Impact of gestational diabetes mellitus on maternal cardiac adaptation to pregnancy

Preeclampsia: a gestational cardiorenal syndrome

Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

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