Maternal Cardiac Dysfunction and Remodeling in Women With Preeclampsia at Term

Abstract

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...

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

“…Importantly, preeclampsia involves multisystem dysfunction. There is evidence of structural and functional cardiac impairments in women during pregnancies complicated by preeclampsia 12, 13, 14. Biomarkers of cardiac remodeling are also elevated during these pregnancies 15…”

Evaluation of Echocardiographic Systolic Parameters in Pre-Eclamptics and Normotensives Women

“…Karen et al [1] also found TVR to be higher in the PIH group as compared to the controls mainly due to vasoconstriction.…”

“…The incidence of pre-eclampsia in nulliparous women ranges from 3 to 10 % [1]. Acute preeclampsia is associated with significantly higher prevalence of asymptomatic abnormal global left ventricular (LV) abnormal function/geometry and myocardial injury [1].…”

“…The incidence of pre-eclampsia in nulliparous women ranges from 3 to 10 % [1]. Acute preeclampsia is associated with significantly higher prevalence of asymptomatic abnormal global left ventricular (LV) abnormal function/geometry and myocardial injury [1]. It is also associated with significantly higher risk of subsequent heart failure, ischaemic and hypertensive heart diseases, and related mortality compared with uneventful pregnancy in later life [2,3].…”

Impact of a History of Hypertension in Pregnancy on Later Diagnosis of Atrial Fibrillation

“…Acute myocardial manifestations of the HPDs include concentric remodeling, left ventricular hypertrophy, and diastolic dysfunction,10 which results in left atrial enlargement,11 accompanied by increased atrial natriuretic peptide levels 12. Over the long term, women with a history of HPD have higher left ventricular mass and higher prevalence (odds ratio: 1.4) of left ventricular hypertrophy compared with women with normotensive pregnancies,13 as well as a higher likelihood of an abnormal index of myocardial performance 14…”