Relationship of systemic hemodynamics, left ventricular structure and function, and plasma natriuretic peptide concentrations during pregnancy complicated by preeclampsia

Borghi, Claudio; Esposti, Daniela Degli; Immordino, Vincenzo; Cassani, A.; Boschi, Stefano; Bovicelli, Luciano; Ambrosioni, Ettore

doi:10.1067/mob.2000.105684

Cited by 59 publications

(61 citation statements)

References 23 publications

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“…We found that, similar to findings of previous studies (12,14,15), despite the hemodynamic load of pregnancy, most healthy pregnant women have low and stable concentrations of BNP throughout pregnancy and after delivery. This suggests that healthy women are, in general, able to compensate for the increased volume load that occurs during pregnancy (16).…”

Section: Discussionsupporting

confidence: 91%

“…Three women with heart disease and baseline measurements had spontaneous abortions (aortic regurgitation after repair of a sinus of Valsalva rupture [n ϭ 1], stenotic bicuspid aortic valve [n ϭ 1], Marfan syndrome with mitral regurgitation [n ϭ 1]) and were not included in the outcome analyses. One woman without heart disease was recruited but developed preeclampsia and was also not included in any analyses, due to the reported association between preeclampsia and elevations in natriuretic peptides (12,13). BNP during pregnancy in women with and without heart disease.…”

Section: Resultsmentioning

confidence: 99%

“…In women with preeclampsia, natriuretic BNP levels are increased compared with healthy pregnant women (13,14). This is paralleled by increased LV wall mass and LV chamber dimensions (12). Furthermore, crystalloid infusion in women with preeclampsia leads to further rises in atrial natriuretic peptide levels (19,20), a change not found in healthy pregnant women, suggesting that women with preeclampsia do not adequately compensate in response to volume challenges.…”

Section: Discussionmentioning

confidence: 98%

See 2 more Smart Citations

B-Type Natriuretic Peptide in Pregnant Women With Heart Disease

Tanous

Siu

Mason

et al. 2010

Journal of the American College of Cardiology

183

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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

B-Type Natriuretic Peptide in Pregnant Women With Heart Disease

Tanous

Siu

Mason

et al. 2010

Journal of the American College of Cardiology

183

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show abstract

“…Yuan et al [29] show that the most relevant cardiac structural changes observed in pregnancy-associated hypertension are the increase in left atrial and ventricular diameters as well as in the thickness of the inter-ventricular septum with impaired left ventricular diastolic function and sustained systolic function. These results are in agreement with some previous data [18,20,30] as well as with our findings in patients with PEC in whom we observed a preserved systolic function resulting from an increase in both LV end-systolic and end-diastolic volumes. Conversely, we did not observe significant abnormalities in the LV structure of patients with G-PIH, and this is in agreement with the observations of De Conti et al [31] while others [32] have reached different conclusions starting from a lesser systematic classification of hypertension complicating pregnancy.…”

Section: Discussionsupporting

confidence: 96%

Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy

et al. 2010

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Hypertension in pregnancy is a frequent disorder that includes a spectrum of conditions. We aimed at comparatively evaluating the hemodynamic, echocardiographic and biohumoral profile of a sample of pregnant Caucasian women with different form of pregnancy-related hypertension. We enrolled 39 non-hypertensive pregnant women (NP), 26 with Chronic HBP in pregnancy (CH), 24 with gestational hypertension (G-PIH), and 33 with pre-eclampsia. We recorded and compared blood pressure (BP), echocardiographic parameters, resting plasma renin activity (PRA) and plasma aldosterone (PA), Plasma levels of atrial (ANP) and brain natriuretic peptide (BNP). PE patients had a significantly higher BP than either G-PIH or NP patients. PE patients had also significantly lower cardiac output than NP, G-PIH and CH. In comparison to NP patients, the total peripheral vascular resistance was 61% higher in PE women and 38% higher in CH patients. All echographic parameters were significantly more altered in PE patients when compared with NP, in respect to any other form of hypertension. Either ANP (+35%) and BNP (+40%) were significantly higher in PE patients than in controls. The PRA was reduced in PE and CH patients when compared either with NP (-38 and -35%, respectively) or G-PIH (-47 and -43%, respectively). On the basis of our data, we can conclude that PE is the gestation associated hypertension with the largest anatomical, functional and biohumoral involvement, and so it has to be involved in a more intensive monitoring and evaluation.

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“…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…”

Section: Introductionmentioning

confidence: 99%

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

Scantlebury

Kattah

Weissgerber

et al. 2018

JAHA

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BackgroundAtrial fibrillation/flutter (AF) produces significant morbidity in women and is typically attributed to cardiac remodeling from multiple causes, particularly hypertension. Hypertensive pregnancy disorders (HPDs) are associated with future hypertension and adverse cardiac remodeling. We evaluated whether women with AF were more likely to have experienced a HPD compared with those without.Methods and ResultsA nested case–control study was conducted within a cohort of 7566 women who had a live or stillbirth delivery in Olmsted County, Minnesota between 1976 and 1982. AF cases were matched (1:1) to controls based on date of birth, age at first pregnancy, and parity. AF and pregnancy history were confirmed by chart review. We identified 105 AF cases: mean age 57±8 (mean±SD) years, (controls 56±8 years), 32±8 years (controls 31±8 years) after the first pregnancy. Cases were more likely to have obesity during childbearing years, and hypertension, diabetes mellitus, dyslipidemia, coronary disease, valvular disease, and heart failure at the time of AF diagnosis. Cases were more likely to have a history of HPDs, compared with controls: 28/105 (26.7%) cases versus 12/105 (11.4%) controls, odds ratio: 2.60 (95% confidence interval, 1.21–6.04). After adjustment for hypertension and obesity, the association was attenuated and no longer statistically significant; odds ratio (95% confidence interval, 2.12 (0.92–5.23).ConclusionsWomen with AF are more likely to have had a HPD, a relationship at least partially mediated by associated obesity and hypertension. Given the high morbidity of AF, studies evaluating the benefit of screening for and management of cardiovascular risk factors in women with a history of HPD should be performed.

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Relationship of systemic hemodynamics, left ventricular structure and function, and plasma natriuretic peptide concentrations during pregnancy complicated by preeclampsia

Cited by 59 publications

References 23 publications

B-Type Natriuretic Peptide in Pregnant Women With Heart Disease

B-Type Natriuretic Peptide in Pregnant Women With Heart Disease

Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy

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

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