Preeclampsia Predicts Risk of Hospitalization for Heart Failure With Preserved Ejection Fraction

Williams, Dominique; Stout, Molly J.; Rosenbloom, Joshua I.; Olsen, Margaret A.; Maddox, Karen E. Joynt; Deych, Elena; Dávila‐Román, Víctor G.; Lindley, Kathryn J.

doi:10.1016/j.jacc.2021.09.1360

Cited by 51 publications

(46 citation statements)

References 36 publications

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“…This is also confirmed by the fact that all three myocardial layers were more affected in early vs. late-onset preeclampsia in a study performed using layer specific STE [75]. Moreover, a very recent study demonstrated that preeclampsia can predict the risk of hospitalization for heart failure with preserved ejection fraction [76]. It is known that women represent the majority of patients with heart failure with preserved ejection fraction [77].…”

Section: Discussionmentioning

confidence: 60%

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Pregnancy Complications Lead to Subclinical Maternal Heart Dysfunction—The Importance and Benefits of Follow-Up Using Speckle Tracking Echocardiography

et al. 2022

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Pregnancy complications such as gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) are frequent and influence not only fetal outcomes but also the maternal cardiac function. GDM and HDP may act as a proxy for increased metabolic and cardiovascular risk later in life. Speckle tracking echocardiography (STE) is a relatively new imaging technique that provides more sensitive assessment than conventional echocardiography of the maternal cardiac function. Recent research suggests that STE can be used during pregnancy and postpartum as a useful method of early detection of subclinical maternal cardiac changes related to pregnancy complications, such as GDM and HDP, and as an indicator for future maternal cardiovascular disorders. The aim of this review was to underline the current value of STE in the follow-up protocol of high-risk pregnant women, as a mean for pre- and postpartum monitoring. A review of the literature was conducted in the PubMed database to select relevant articles regarding the association of STE changes and HDP or GDM in the prenatal and postpartum maternal evaluations. Both GDM and HDP are associated with subtle myocardial changes in shape, size and function; these preclinical cardiac changes, often missed by conventional evaluation, can be detected using STE. Left ventricular global circumferential strain might be an important predictor of maternal cardiovascular disorders and might help to define a high-risk group that requires regular monitoring later in life and timely intervention.

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Section: Discussionmentioning

confidence: 60%

“…It is known that women represent the majority of patients with heart failure with preserved ejection fraction [77]. However, it is surprising and disquieting that the median time to heart failure onset was only 32.2 months postpartum in the previously mentioned study [76].…”

Section: Discussionmentioning

confidence: 77%

Pregnancy Complications Lead to Subclinical Maternal Heart Dysfunction—The Importance and Benefits of Follow-Up Using Speckle Tracking Echocardiography

et al. 2022

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“…In contrast to prior studies, our ability to leverage angiography testing at a province-wide level enabled us to not only evaluate for coronary artery stenosis, but also the degree of disease severity. By excluding women with pre-existing heart disease and assessing study outcomes starting at 42 days after discharge from the index birth hospitalisation, our results also avoided the described higher short-term risk of coronary artery dissection or heart failure as a direct consequence of uncontrolled blood pressure with acute pre-eclampsia 17 23 24…”

Section: Discussionmentioning

confidence: 99%

Severity of obstructive coronary artery stenosis after pre-eclampsia

Ray

Austin

Park

et al. 2022

Heart

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IntroductionWomen with a history of pre-eclampsia are at higher risk of premature coronary artery disease. Assessment of obstructive coronary artery stenosis by invasive coronary angiography has not been evaluated after pre-eclampsia.MethodsA population-based cohort study was completed in Ontario, Canada, where there is universal healthcare and collection of angiographic data. Included were women with a live birth or stillbirth from 2002 to 2020, and without known heart disease. One birth was randomly selected per woman. The main exposure compared women with versus without pre-eclampsia. The primary outcome was angiographically established obstructive coronary artery stenosis, assessed starting 42 days after the index birth. Cause-specific hazard models accounting for competing risks generated HRs, adjusted for age, parity, income, rurality, diabetes, chronic hypertension, renal disease, substance use and dyslipidaemia.ResultsAmong 42 252 women ever with pre-eclampsia and 1359 122 never with pre-eclampsia, mean age was 31.1 years and 30.6 years, respectively. After 9 years of follow-up, obstructive coronary artery stenosis occurred in 186 women with pre-eclampsia (4.53 per 10 000 person-years) versus 1237 women without pre-eclampsia (0.97 per 10 000 person-years)—an unadjusted HR 4.41 (95% CI 3.78 to 5.14) and adjusted HR 2.07 (95% CI 1.77 to 2.43). Relative to those with neither, the adjusted HR for coronary stenosis was highest in women with pre-eclampsia and preterm birth (3.11, 95% CI 2.51 to 3.87), or pre-eclampsia and stillbirth (2.80, 95% CI 1.05 to 7.47).ConclusionsPre-eclampsia is associated with a greater risk of premature-onset obstructive coronary artery stenosis, especially when it is complicated by a preterm birth or a stillbirth.

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“…Preeclampsia is also a significant risk factor for peripartum cardiomyopathy (see below) and for heart failure with preserved ejection fraction. 19 In the long-term, preeclampsia is associated with 3-fold excess of CVD. 18 Many pathways related to angiogenesis, inflammation, syncytiotrophoblast stress, and autoantibodies have been proposed to play a role in the pathogenesis of preeclampsia.…”

Section: Disease Models Of Cardiovascular Complications Of Pregnancy ...mentioning

confidence: 99%

Animal Models of Cardiovascular Complications of Pregnancy

Arany

Hilfiker‐Kleiner

Karumanchi

2022

Circulation Research

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Cardiovascular complications of pregnancy have risen substantially over the past decades, and now account for the majority of pregnancy-induced maternal deaths, as well as having substantial long-term consequences on maternal cardiovascular health. The causes and pathophysiology of these complications remain poorly understood, and therapeutic options are limited. Preclinical models represent a crucial tool for understanding human disease. We review here advances made in preclinical models of cardiovascular complications of pregnancy, including preeclampsia and peripartum cardiomyopathy, with a focus on pathological mechanisms elicited by the models and on relevance to human disease.

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Preeclampsia Predicts Risk of Hospitalization for Heart Failure With Preserved Ejection Fraction

Cited by 51 publications

References 36 publications

Pregnancy Complications Lead to Subclinical Maternal Heart Dysfunction—The Importance and Benefits of Follow-Up Using Speckle Tracking Echocardiography

Pregnancy Complications Lead to Subclinical Maternal Heart Dysfunction—The Importance and Benefits of Follow-Up Using Speckle Tracking Echocardiography

Severity of obstructive coronary artery stenosis after pre-eclampsia

Animal Models of Cardiovascular Complications of Pregnancy

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