Left ventricular dysfunction in preeclampsia: an echocardiographic study

Abstract

INTRODUCTIONPreeclampsia is an acute increase in blood pressure during the second half of pregnancy which is short-lived. More than 50% of the women with elevated blood pressure during pregnancy return to normal by 6-12 weeks postpartum. In developing countries preeclampsia ranks second to anaemia as a cause of maternal morbidity and mortality complicating 7-10% of all pregnancies.Preeclampsia is associated with both immediate and long term postpartum morbidity and mortality due to cardiac related issues.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 heart. Preeclampsia causes left ventricle dysfunction and myocardial injury. Significant proportion of preeclamptic patients show cardiopulmonary morbidity and autopsy ABSTRACT Background: Preeclampsia is a pregnancy specific disorder which constitutes hypertension and proteinuria after 20 weeks of gestation. It is a multisystem disorder of unknown etiology. Preeclampsia is associated with significantly higher prevalence of asymptomatic global left ventricular function and myocardial injury than uneventful pregnancy. This study was undertaken to evaluate the Left ventricular changes in preeclamptic women and to compare with normotensive women. Methods: This prospective study on left ventricular systolic and diastolic function by echocardiography was undertaken in normal and preeclamptic pregnant women who got admitted during the period of one year from January 2015 to December 2015 at Government Mohan Kumaramangalam Medical College and Hospital, Salem. Study population was divided into two groups. GROUP 1-Preeclamptic pregnant women GROUP 2-Normotensive pregnant women as control. Results: There were significant differences in the mean end diastolic dimensions when compared to systolic dimension between two groups. Conclusions: Women with preeclampsia have significant systolic and diastolic dysfunction compared to normotensive pregnant women. Effective management of patients who showed left ventricular dysfunction prevented pulmonaryedema and cardiac failure. This study emphasizes the importance of identifying this subset of preeclamptic patients with ECHO changes who are at higher risk of developing cardiovascular complications later in life by undergoing echocardiography.

Incidence and Outcome of Left Ventricular Dysfunction in Asymptomatic Pregnant Women-An Institutional Study

“…In preeclamptic women, the elevated after load is linked with a reduced emptying of the left ventricle and elevated End Systolic Pressure. [5,11] In our study, we found the mean LVESV was 25-51 ml in preeclamptic women when compared to 22-27 ml in normotensives. The mean LVEDV was 84-138 ml in preeclamptic when compared to 100-109 ml in normotensives.…”

“…This might be the probable mechanism by which diastolic dysfunction develops independent of left ventricular hypertrophy. [5,10] On a whole we found left ventricular dysfunction in 3% of asymptomatic pregnant women on echocardiography done in third trimester with EF of < 45%. One patient had severe LV dysfunction and bronchospasm component (EF=30%).…”

“…Patients can even be followed during the postpartum period to examine whether the altered hemodynamic state reverts to normal after pregnancy. [5,10,11] Our study emphasizes the importance of identifying this subset of preeclamptic patients with ECHO changes who are at higher risk of developing cardiovascular complications later in life by undergoing echocardiography. Effective management of patients who showed left ventricular dysfunction prevented pulmonary edema and cardiac failure.…”

“…Echocardiography is cheap, non invasive modality, with no radiation risk to mother and fetus to evaluate pregnant women for left ventricular dysfunction. [5,6] We carried this study to evaluate the incidence and outcome of left ventricular dysfunction in asymptomatic pregnant women, both hypertensives and normotensives.…”

Frequency Of Diastolic Dysfunction In Preeclamptic Women Visiting Obs. & Gynaecology at LUMHS Jamshoro

“…Subha Sivagami Sengodan et al in their case control study included 200 patients with preeclampsia as cases and 200 normotensive patients as control. They found significance of diastolic dysfunction in pre eclamptic group 16 . Similar results were reported by Shivananjiah, et al 17 who found marked LV changes in preeclamptic patients.…”