Acute Cardiac Effects of Severe Pre-Eclampsia

Arthur Jason Vaught, Lara C. Kovell, Linda M. Szymanski, Susan A. Mayer, Sara M. Seifert, Dhananjay Vaidya, Jamie D. Murphy, Cynthia Argani, Anna O'Kelly, Sarah York, Pamela Ouyang, Monica Mukherjee, Sammy Zakaria

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalJournal of the American College of Cardiology
Volume72
Issue number1
DOIs
StatePublished - Jul 3 2018

Keywords

  • diastolic dysfunction
  • echocardiography
  • pre-eclampsia
  • pulmonary edema
  • right ventricular systolic pressure
  • speckle tracking echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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