Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Abstract

Objective To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia.Design This was a prospective screening study.Setting The Homerton University Hospital, a London teaching hospital.Population Two hundred and ten low-risk women with a singleton pregnancy were analysed.Methods Radial artery pulse waveforms were measured between the 11 +0 and 13 +6 weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve.Main outcome measures Prediction of pre-eclampsia by AIx-75.Results Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia.Conclusion First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening.

Early pregnancy maternal cardiovascular profiling in the prediction of hypertensive disease in pregnancy

“…These results are consistent with the finding of the higher augmentation index in the pulse pressure wave using systolic phase analysis in pre-eclamptic pregnancies previously reported [13]. With differences in the vasculature being clinically apparentonwith pulse pressure wave analysis in early pregnancy, women at increased risk of developing pre-eclampsia could be selected for more intensive antenatal monitoring or therapy (when developed) aimed at the prevention of the disease by detecting women at risk of pre-eclampsia in the first trimester of pregnancy as opposed to the second trimester when the pathological changes of pre-eclampsia are already established and may be irreversible.…”

Maternal Hemodynamics at 11–13 Weeks’ Gestation in Gestational Diabetes Mellitus

“…The mechanism linking abnormal vascular markers and GDM may be analogous to hypertensive disorders, in which women destined to develop cardiovascular disease in their 40s or 50s often present with PE in their 20s or 30s [30]. As in the case of GDM, there is increased SBP Ao and arterial stiffness in women with clinically established PE, but this is also apparent at 11–13 weeks’ gestation several months before the clinical onset of the disease [16,31,32,33,34]. …”

Preeclampsia and Vascular Function: A Window to Future Cardiovascular Disease Risk

“…64 In addition, results of one study found that PWA measured between 11(+0) and 13(+6) weeks of gestation was able to predict 79% of women who developed preeclampsia and 88% of women who developed severe early-onset preeclampsia, with a falsepositive rate of 11%. 65 PWV may be especially useful for predicting preeclampsia in high-risk women. A recent study looked at the detection rate of five potential diagnostic markers for preeclampsia in high-risk women between 22 and 26 weeks of gestation as follows: PWV, serum levels of sFlt-1 and uric acid, and 24-hour calcium and protein excretion.…”