Maternal left ventricular and endothelial functions in preeclampsia (original) (raw)
2012, Acta Obstetricia et Gynecologica Scandinavica
Objective. To compare maternal left ventricular and endothelial functions in preeclampsia and normal pregnancy, during pregnancy and after delivery. Design. Observational study with follow-up. Setting. University hospital and midwife-led antenatal care center. Samples. Twenty untreated women with preeclampsia and 20 women with normal pregnancy, matched for gestational age and parity. Methods. The women were examined during pregnancy and three months after delivery. Left ventricular function was assessed by echocardiography, including tissue-Doppler imaging. Endothelial function was assessed by measuring flow-mediated dilation of the brachial artery. Main outcome measures. Early diastolic mitral annular tissue velocity, "e", peak systolic tissue velocity, "S", and flow-mediated dilation. Results. The diastolic function was reduced in preeclampsia, with lower "e", and there was a higher ratio of early diastolic mitral inflow velocity and early diastolic mitral annular velocity, "E/e". Early diastolic mitral inflow deceleration time and isovolumetric relaxation time were similar between the groups, suggesting pseudonormalization and increased filling pressures in preeclampsia. "S" was lower in the preeclampsia group during pregnancy. Both diastolic and systolic left ventricular functions normalized postpartum. The flow-mediated dilation was impaired in the preeclampsia group both during pregnancy and three months after delivery. Conclusions. The maternal left ventricular function was impaired during preeclampsia but had normalized three months after delivery. The endothelial function, measured by flow-mediated dilation, was impaired in the preeclampsia group as compared with the normal pregnancy group both during pregnancy and three months after delivery.
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2016
Abstract—In subjects with previous preeclampsia, differences in cardiovascular and/or blood biochemical parameters are present in the nonpregnant state, and a simultaneous assessment of multiple derived indices better differentiates between women with or without previous preeclampsia. We examined 18 previous preeclamptic and 50 previous uncomplicated pregnancies, 16 months postpartum. Cardiovascular assessment included the following: (1) systemic hemodynamics and mechanics (Doppler echocardiography, tonometry, and oscillometric sphygmomanometry); (2) endothelial function (plethysmography); (3) left ventricular properties (echocardiography); and (4) blood biochemical analyses. Compared to women with previous uncomplicated pregnancies, previous preeclamptics had higher mean (801 versus 863 mm Hg; P0.04) and diastolic (641 versus 682 mm Hg; P0.04) pressures and total vascular resistance (156237 versus 1784114 dyne s/cm5; P0.03). Systolic blood pressure, arterial compliance, and left ve...
Effect of Preeclampsia on Fetal Cardiac Output
Eastern Journal of Medicine, 2023
We hypothesized that there may be a change in fetal cardiac output due to the increase in placental vascular resistance in pregnancies with preeclampsia. We aimed to compare fetal cardiac output values in pregnancies with preeclampsia and healthy pregnancies. This prospective case-control study involves 32 pregnant women with preeclampsia and 32 healthy women between the 32-34 gestational weeks. Right and left ventricular outflow systolic peak flow velocities (PSV) were measured and the velocity-time integral (VTI) was obtained by manually tracing the area under the PSV waveform. Stroke volume (SV) was obtained by multiplying the aortic and pulmonary valve cross-sectional area by the VTI. Cardiac output (CO) was found by multiplying the right and left SV with the fetal heart rate per minute (FHR). Right and left car diac output values were compared between the study groups. The left CO value was lower in the PE group, but this difference was not statistically significant. Right cardiac output was found to be significantly lower in the PE group (p<.001). Although umbil ical artery and ductus venosus pulcatility index (PI) were higher and middle cerebral artery PI was lower in the preeclampsia group, these differences were not statistically significan t. The presented study shows that the right ventricular output significa ntly decreased due to abnormal placentation, increased placental vascular resistance and high afterload in pregnancies with preeclampsia.
International Journal of Clinical Obstetrics and Gynaecology, 2019
Background: Pre-eclampsia (PE) is associated with maternal cardiac remodelling and biventricular diastolic dysfunction. Preterm PE alone can also be associated with severe left ventricular hypertrophy and biventricular systolic dysfunction. Aim & Objectives of the study: The aim of this study was to assess whether the maternal cardiovascular profile at mid-gestation in nulliparous normotensive women differs in women destined to develop preterm PE versus those who will develop PE at term. Results: The study includes only nulliparous women with singleton pregnancy and at increased risk of developing PE. Risk for developing PE is determined by uterine artery Doppler assessment at the routine ultrasound assessment at 20-23 weeks of gestation. In order to achieve the aims and objective of study, 115 cases of mid gestational pregnant women were taken in the sample for study. These cases were classified into 4 groups i) low risk women with uneventful outcome (59 No's), ii) high risk women with uneventful outcome (35 No's), iii) high risk women who developed Term PE (13 No's) and iv) high risk women who developed preterm PE (8 No's). As per the protocol of the study data were collected on demographic profile, clinical profile and analyzed following appropriate statistical tools and techniques. The distribution of age among the four groups of patients were found to be more or less homogeneous as per the chi square test of association (p=0.411). Among the low risk women with uneventful outcome, all were having normal BMI. Among the high risk women with uneventful outcome 11.4% were overweight. The pair wise comparison of MAP by groups with the help of Mann-Whitney U test. It was clearly revealed that high risk women irrespective of status of event were having more or less the same MAP value with p=0.727, p=0.731, p=0.8 respectively. High risk women with or without uneventful outcome have clearly higher value of MAP than the low risk women with uneventful outcome (p=0.000). The Kruskal Wallis test revealed no significant difference in heart rate of the 4 groups of pregnant women (p=0.224). The stroke volume of each of the 3 groups of HRW with uneventful outcome, term PE and preterm PE was significantly lower than LRW with uneventful outcome with p value=0.000 for each of them. HRW with preterm PE have significantly lower stroke volume index than HRW with uneventful outcome (p=0.003). HRW with preterm PE and term PE do not differs significantly in stroke volume index (p=0.638). The comparison of cardiac output by groups is presented in table 10. The lowest median value of 3.79 L/min (3.67 L/min-3.96 L/min) was observed among HRW with preterm PE which gradually increased to 4.9 L/min (4.6 L/min-5.12 L/min) among LRW with uneventful outcome and the difference was found to be significant (p=0.000). The frequency distribution of cardiac index gradually shift to right from HRW with preterm PE to LRW with uneventful outcome signifying lower stroke volume index for HRW with uneventful outcome, with term PE and preterm PE in descending order. The frequency distribution of LVMi depicted that the distribution of LRW with uneventful outcome is more or less symmetrical whereas in case of 3 HRW groups the distribution is right screwed. The frequency distribution of left ventricular wall thickness, It clearly emerged that the distribution of LRW with uneventful outcome is relatively towards the left of the axis than the other three HRW groups. There is a significantly higher prevalence of LV remodelling /hypertrophy at mid-gestation in both preterm PE and term PE women. Asymptomatic cardiac diastolic dysfunction, impaired relaxation, altered geometry at mid gestation is only seen in high risk pregnant women with pre term preeclampsia but not in those with term preeclampsia. Conclusion: It is now evident that women who developed preterm PE in pregnancy have a much higher incidence of developing symptomatic heart failure many years after delivery. Although it is not possible to distinguish pre-existing cardiac dysfunction from that acquired as a result of pregnancy, these cardiac findings may be useful in understanding the cardiovascular pathophysiology of PE.
BJOG: An International Journal of Obstetrics & Gynaecology, 2012
Objective Pre-eclampsia (PE) is associated with maternal cardiac remodelling and biventricular diastolic dysfunction. Preterm PE alone can also be associated with severe left ventricular hypertrophy and biventricular systolic dysfunction. The aim of this study was to assess whether the maternal cardiovascular profile at mid-gestation in nulliparous normotensive women differs in women destined to develop preterm PE versus those who will develop PE at term. Design Prospective study. Setting Tertiary referral university centre. Population A total of 269 women, including 152 at increased risk of developing PE as determined by mid-gestational uterine artery Doppler assessment. Methods Women underwent blood pressure profiling, echocardiography, cardiac tissue Doppler and strain rate analysis at 20-23 weeks of gestation. Main outcome measures Mid-gestational cardiovascular profile in women with normal pregnancy and those that subsequently developed preterm or term PE. Results Pre-eclampsia subsequently developed in 46 women, including 18 with preterm PE. Women who subsequently developed PE, irrespective of gestation, had evidence of left ventricular concentric remodelling (33%) which was not found in the control women (P < 0.0001). Only women who developed preterm PE exhibited a high resistance-low volume haemodynamic state at mid-gestation. The latter group also had evidence of left ventricular diastolic or systolic dysfunction (33%) and segmental impaired myocardial relaxation (72%). Conclusions Asymptomatic cardiac diastolic dysfunction is evident at mid-gestation in women who subsequently develop preterm PE but not in those who develop term PE. These cardiac findings are useful in understanding the pathophysiology of PE and corroborate the concept that PE is not a single disorder, but a cluster of symptoms that have several different aetiologies.
Maternal Cardiac Dysfunction and Remodeling in Women With Preeclampsia at Term
Preeclampsia is a disease associated with significant cardiovascular morbidity during pregnancy and in later life. This study was designed to evaluate cardiac function and remodeling in preeclampsia occurring at term. This was a prospective case– control study of 50 term preeclampsia and 50 normal pregnancies assessed by echocardiography and tissue Doppler analysis. Global diastolic dysfunction was observed more frequently in preeclampsia versus control pregnancies (40% versus 14%, P0.007). Increased cardiac work and left ventricular mass indices suggest that left ventricular remodeling was an adaptive response to maintain myocardial contractility with preeclampsia at term. Approximately 20% of patients with preeclampsia at term have more evident myocardial damage. Diastolic dysfunction usually precedes systolic dysfunction in the evolution of ischemic or hypertensive cardiac diseases and is of prognostic value in the prediction of long-term cardiovascular morbidity. The study findings also have significant implications for the acute medical management of preeclampsia. (Hypertension. 2011;57:00-00.)
IOSR Journals , 2019
Background Cardiac disease is being the leading non obstetric cause of death in pregnancy and puerperium. Hypertensive disorders constitute 5-10% of all pregnancies, being one of the components of deadly triad with hemorrhage and infection. Preeclampsia is a pregnancy complication of placental etiology with acute onset of predominantly cardiovascular manifestations and constitutes 2-7% of medical disorders in pregnancies. In India, preeclampsia accounts for approximately 8-14% of maternal deaths. There is limited knowledge with respect to parameters of cardiac function in pregnancy and even less in the presence of pregnancy complications such as preeclampsia. In preeclampsia mean arterial pressure and total vascular resistance are increased resulting in increased afterload on heart. Transthoracic echocardiography is frequently considered the reference standard for cardiovascular system monitoring. It is a non-invasive, precise device and is validated in pregnancy. Aim & Objective:- To compare the echocardiography parameters in pregnant women with new onset hypertension and normotensive pregnant women after 28 weeks of gestational age. Methods:- This is a hospital based observational case control study carried out in the departments of obstetrics and gynecology and cardiology at Gandhi hospital during the study period. Patients were enrolled in the study after applying the inclusion and exclusion criteria. On admission subjects are assessed clinically, appropriate biochemical tests done. • The subjects were studied by standard 2 – dimensional and Doppler transthoracic echocardiography in the left lateral decubitus position and data acquired at end expiration from standard parasternal/apical views. Results:- In the present study, it is observed mean heart rate is 82.9bpm in cases and 84 bpm in controls. It is observed that mean stroke volume index in cases is 39.05 and in controls is 39.06. Cardiac work index (CWI) is increased in cases compared to controls. Mean CWI in cases is 385 and in controls are 288.89.Mean E wave velocity in cases is 0.79 m/s and in controls are 0.82 m/s. A wave is increased in cases which is statistically significant. Mean A wave velocity in cases is 0.65 m/s and in controls is 0.60 m/s. E/A ratio is reduced in cases which is statistically significant. Mean E/A ratio in cases is 1.22 and in controls is 1.35.In the present study it is observed Left ventricular mass index (LVMI) is increased in cases compared to controls. Mean LVMI in cases is 75.26 gm/m² and in controls is 70.48 gm/m². Conclusion:- Preeclampsia is a multisystem disease complicating 5-10% of pregnancies and remains in the top three causes of maternal morbidity and mortality globally. In women with preeclampsia cardiac work index ,left ventricular mass index,left ventricular posterior wall diameter and interventricular septal thickness are increased as a result of increased workload on heart to maintain cardiac output against increased after load.Systolic function is well preserved. Diastolic function is reduced and those with global diastolic dysfunction are at increased risk of developing pulmonary edema.
Preeclampsia Is Associated With Persistent Postpartum Cardiovascular Impairment
Preeclampsia is associated with asymptomatic global left ventricular abnormal function and geometry during the acute phase of the disorder. These subclinical abnormalities in cardiac findings are known to be important in cardiovascular risk stratification for nonpregnant patients. Furthermore, epidemiological studies have also demonstrated a relationship between preeclampsia and cardiac morbidity and mortality later in life. The aim of this study was to evaluate the postpartum natural history and clinical significance of asymptomatic left ventricular impairment known to occur with acute preeclampsia. This was a prospective longitudinal case-control study of 64 subjects with preeclampsia and 78 matched controls. There were 3 time point assessments, pregnancy and 1 and 2 years postpartum. The assessments included a medical and family history, blood pressure profile, echocardiography, and 12-lead ECG. At 1 year postpartum, asymptomatic left ventricular moderate-severe dysfunction/hypertrophy was significantly higher in preterm preeclampsia (56%) compared with term preeclampsia (14%) or matched controls (8%; P values 0.001). The risk of developing essential hypertension within 2 years was significantly higher in both preterm preeclamptic women and those with persistent left ventricular moderate-severe abnormal function/geometry. The cardiovascular implications of preeclampsia do not end with the birth of the infant and placenta. The majority of preterm preeclamptic women have stage B asymptomatic heart failure postpartum, and 40% develop essential hypertension within 1 to 2 years after pregnancy. Women with a history of preterm preeclampsia may benefit from formal cardiovascular risk assessment in the 1 to 2 years after delivery to identify those who would benefit from targeted therapeutic intervention. (Hypertension. 2011;58:709-715.)
Cardiovascular Implications in Preeclampsia: An Overview
Recent data demonstrate a significant and previously undiscovered cardiovascular burden in pregnancy that is exacerbated if preeclampsia develops. The heart undergoes remodeling in pregnancy with increases in chamber dimensions, LV wall thickness, and mass that is consistent with a process of remodeling/hypertrophy. The likelihood of developing preeclampsia is increased by many maternal demographic and medical characteristics, such as hypertension, obesity, and age, which interestingly are also indicative of increased cardiovascular risk. This finding reinforces the hypothesis that a preexisting tendency to increased cardiovascular risk, particularly hypertension, increases a women’s susceptibility to developing preeclampsia. Understanding the extent and severity of cardiovascular changes has brought new insights into the optimal management of women with preeclampsia. It is now also apparent that the postpartum recovery from preeclampsia is compromised by asymptomatic cardiovascular dysfunction. Although it is not yet evident whether preeclampsia causes permanent myocardial damage or whether the women had prepregnancy cardiovascular deficits, the development of preeclampsia represents a unique opportunity to identify women at high risk of long-term CVD before other conventional cardiovascular risk factors become clinically apparent. The optimal management of these women at high risk of long-term cardiovascular morbidity and mortality remains a considerable challenge.
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