Pre‐eclampsia and long‐term cardiac dysfunction: A review of asymptomatic cardiac changes existing well beyond the post‐partum period

Abstract

Background: Pre-eclampsia is a disease of pregnancy characterised by the manifestations of multi-organ dysfunction. The recent use of transthoracic echocardiography in the assessment of women with pre-eclampsia has allowed the detection of cardiac systolic and diastolic dysfunction in the acute phase. Women with a history of pre-eclampsia also have increased lifelong risks of cardiovascular disease and mortality that persists well beyond the post-partum period. These developments raise the possibility that pre-eclampsia may be an early marker of cardiovascular disease and the potential role for echocardiography in guiding the detection and management of this. This review aims to summarise the existing evidence of echocardiographic cardiac assessment of women with a history of pre-eclampsia performed more than 12 weeks post-partum. Methods: A systematic search of PubMed and OVID EMBASE databases was performed to identify studies featuring assessment of cardiac function performed after 12 weeks post-partum in women with a history of pre-eclampsia. Studies without post-partum cardiac assessment or with other documented causes for cardiomyopathy were excluded. Results: Thirteen studies were identified that measured cardiac function by transthoracic echocardiography between 6 months and 18 years following a pregnancy complicated by pre-eclampsia. Common findings across the studies were of increased diastolic dysfunction, increased left ventricular mass index (LVMI) and concentric hypertrophy in women with a history of preeclampsia, as compared to women with uncomplicated pregnancy histories. This was predominantly seen in those with a history of early or preterm pre-eclampsia. Conclusions: Women with a history of early or preterm pre-eclampsia have an increased prevalence of diastolic dysfunction. This review demonstrates that the cardiac dysfunction associated with previous pre-eclampsia is quantifiable and persistent. Progression of heart failure from asymptomatic to symptomatic stages carries a fivefold increase in mortality. The use of echocardiography could detect cardiac dysfunction in the asymptomatic stage and guide more intensive risk factor modification in these women.

Pathophysiology of Preeclampsia-Induced Vascular Dysfunction and Implications for Subclinical Myocardial Damage and Heart Failure

“…When echocardiography is performed postpartum (with follow-up from 6 months to 18 years postpartum), hallmarks of preeclampsia include diastolic dysfunction, reduced global longitudinal strain, and concentric LV hypertrophy ( Figure 2 ). 57 , 62 , 63 At 1 year postpartum, nearly half of women with early 64 , 65 and severe 66 preeclampsia exhibit grade I-II diastolic dysfunction. Worsening diastolic function is reported within 2 years postpartum, is more prevalent with early preeclampsia, and may persist for 10 or more years postpartum.…”

Lactic Dehydrogenase Enzyme and Acid-Base Status in Severe Preeclampsia: A Case-Control Study Investigating the Impact of Obesity

“…Considering our data, we can add to the observations of Wheeler et al [11] that all patients with a base deficit greater than -8 mmol/L with any BMI should be considered candidates for an intentional echocardiogram to determine the characteristics of left ventricular function and potential abnormalities early. This is particularly important because a series of structural and functional changes of the left ventricle related to preeclampsia have been described, the alterations mark the beginning of permanent adverse modifications that do not reverse in the postpartum period and that can progress in the long term [21][22][23][24].…”

Del Editor sobre la Salud de la Mujer, embarazo, complicaciones, futuro

“…In most pregnant women, the physiological stress their cardiovascular system undergoes is uncomplicated; however, in women who experience hypertensive disorders of pregnancy, preterm birth and other obstetric complications, this may serve to identify patients at risk for cardiovascular disease, coronary heart disease, stroke, and death caused by these conditions (24) .…”