Noninvasive Assessment of Right Ventricle function and Pulmonary Artery Pressure Using Transthoracic Echocardiography in Women with Pre-eclampsia. An Exploratory Study

Abstract

Objectives: Much less attention has been given to the right heart and pulmonary circulation compared to the left heart and systemic circulation in patients with pre-eclampsia (PEC). We used transthoracic echocardiography (TTE) to estimate pulmonary artery pressure and right ventricular function in women with PEC. Methods: A case-control study at a tertiary care academic center. Ten early PEC (<34 week gestation) and nine late PEC (≥34 weeks gestation) patients with eleven early and ten late gestational age-matched controls. Two dimensional TTE was performed on all patients. The estimated mean PA pressure (eMPAP) was calculated based on pulmonary artery acceleration time (PAAT). Pulmonary vascular resistance (ePVR) was estimated from eMPAP and right ventricular (RV) cardiac output. RV myocardial performance index (RV MPI), tricuspid annular plane systolic excursion (TAPSE), tissue tricuspid annular displacement (TTAD) and lateral tricuspid annular tissue peak systolic velocity (S’) were measured. Results Compared to early controls, in early PEC the eMPAP and ePVR were elevated, PAAT was reduced, RV MPI was increased, TTAD was reduced and TAPSE and TV S’ were unchanged. Compared to late controls, in late PEC, estimated MPAP and estimated PVR were elevated, PAAT was reduced and RVMPI was increased, while TAPSE, TTAD and TV S’ were unchanged. Conclusions: Early PEC is associated with increased eMPAP and ePVR. A subclinical decrement of RV function is noticed. TTE is a useful screening tool for early detection of PH and RV dysfunction in PEC.

Right‐heart dysfunction in women with congenital heart disease and pre‐eclampsia

“…This association was identified in women with corrected tetralogy of Fallot 2 or aortic coarctation 3 , in whom abnormal right‐heart function was demonstrable before conception on both cardiosonography 4 and cardiac magnetic resonance imaging 5 . Right‐heart dysfunction is an intrinsic feature of pre‐eclampsia 6,7 , as is venous hemodynamic dysfunction 8,9 . It is well known that pre‐eclampsia is a risk factor for cardiovascular disease later in life 10 .…”