TY - JOUR
T1 - Acute Cardiac Effects of Severe Pre-Eclampsia
AU - Vaught, Arthur Jason
AU - Kovell, Lara C.
AU - Szymanski, Linda M.
AU - Mayer, Susan A.
AU - Seifert, Sara M.
AU - Vaidya, Dhananjay
AU - Murphy, Jamie D.
AU - Argani, Cynthia
AU - O'Kelly, Anna
AU - York, Sarah
AU - Ouyang, Pamela
AU - Mukherjee, Monica
AU - Zakaria, Sammy
N1 - Funding Information:
This study was funded by a Johns Hopkins University School of Medicine (JHUSOM) Synergy Award. Dr. Vaidya was partially supported by the Johns Hopkins Center for Child and Community Health Research-Biostatistics, Epidemiology and Data Management Core. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Basky Thilaganathan, MD, PhD, served as Guest Editor for this paper.
Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/7/3
Y1 - 2018/7/3
N2 - Background: Pre-eclampsia with severe features (PEC) is a pregnancy-specific syndrome characterized by severe hypertension and end-organ dysfunction, and is associated with short-term adverse cardiovascular events, including heart failure, pulmonary edema, and stroke. Objectives: The authors aimed to characterize the short-term echocardiographic, clinical, and laboratory changes in women with PEC, focusing on right ventricular (RV) systolic pressure (RVSP) and echocardiographic-derived diastolic, systolic, and speckle tracking parameters. Methods: In this prospective observational study, the authors recruited 63 women with PEC and 36 pregnant control patients. Results: The PEC cohort had higher RVSP (31.0 ± 7.9 mm Hg vs. 22.5 ± 6.1 mm Hg; p < 0.001) and decreased global RV longitudinal systolic strain (RVLSS) (−19.6 ± 3.2% vs. −23.8 ± 2.9% [p < 0.0001]) when compared with the control cohort. For left-sided cardiac parameters, there were differences (p < 0.001) in mitral septal e′ velocity (9.6 ± 2.4 cm/s vs. 11.6 ± 1.9 cm/s), septal E/e′ ratio (10.8 ± 2.8 vs. 7.4 ± 1.6), left atrial area size (20.1 ± 3.8 cm2 vs. 17.3 ± 2.9 cm2), and posterior and septal wall thickness (median [interquartile range]: 1.0 cm [0.9 to 1.1 cm] vs. 0.8 cm [0.7 to 0.9 cm], and 1.0 cm [0.8 to 1.2 cm] vs. 0.8 cm [0.7 to 0.9 cm]). Eight women (12.7%) with PEC had grade II diastolic dysfunction, and 6 women (9.5%) had peripartum pulmonary edema. Conclusions: Women with PEC have higher RVSP, higher rates of abnormal diastolic function, decreased global RVLSS, increased left-sided chamber remodeling, and higher rates of peripartum pulmonary edema, when compared with healthy pregnant women.
AB - Background: Pre-eclampsia with severe features (PEC) is a pregnancy-specific syndrome characterized by severe hypertension and end-organ dysfunction, and is associated with short-term adverse cardiovascular events, including heart failure, pulmonary edema, and stroke. Objectives: The authors aimed to characterize the short-term echocardiographic, clinical, and laboratory changes in women with PEC, focusing on right ventricular (RV) systolic pressure (RVSP) and echocardiographic-derived diastolic, systolic, and speckle tracking parameters. Methods: In this prospective observational study, the authors recruited 63 women with PEC and 36 pregnant control patients. Results: The PEC cohort had higher RVSP (31.0 ± 7.9 mm Hg vs. 22.5 ± 6.1 mm Hg; p < 0.001) and decreased global RV longitudinal systolic strain (RVLSS) (−19.6 ± 3.2% vs. −23.8 ± 2.9% [p < 0.0001]) when compared with the control cohort. For left-sided cardiac parameters, there were differences (p < 0.001) in mitral septal e′ velocity (9.6 ± 2.4 cm/s vs. 11.6 ± 1.9 cm/s), septal E/e′ ratio (10.8 ± 2.8 vs. 7.4 ± 1.6), left atrial area size (20.1 ± 3.8 cm2 vs. 17.3 ± 2.9 cm2), and posterior and septal wall thickness (median [interquartile range]: 1.0 cm [0.9 to 1.1 cm] vs. 0.8 cm [0.7 to 0.9 cm], and 1.0 cm [0.8 to 1.2 cm] vs. 0.8 cm [0.7 to 0.9 cm]). Eight women (12.7%) with PEC had grade II diastolic dysfunction, and 6 women (9.5%) had peripartum pulmonary edema. Conclusions: Women with PEC have higher RVSP, higher rates of abnormal diastolic function, decreased global RVLSS, increased left-sided chamber remodeling, and higher rates of peripartum pulmonary edema, when compared with healthy pregnant women.
KW - diastolic dysfunction
KW - echocardiography
KW - pre-eclampsia
KW - pulmonary edema
KW - right ventricular systolic pressure
KW - speckle tracking echocardiography
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U2 - 10.1016/j.jacc.2018.04.048
DO - 10.1016/j.jacc.2018.04.048
M3 - Article
C2 - 29957219
AN - SCOPUS:85048720203
SN - 0735-1097
VL - 72
SP - 1
EP - 11
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -