Maternal Cardiac Function and Preeclampsia

Quick Takes

  • Echocardiography at midgestation is not currently recommended as a screening tool for subsequent development of preeclampsia.
  • Peripheral vascular resistance was higher in patients who developed preeclampsia.

Study Questions:

What is the role of maternal cardiac function in the prediction of preeclampsia?

Methods:

The authors assessed differences in cardiac function (left ventricular systolic and diastolic function, speckle tracking imaging) at midgestation in women who developed preeclampsia versus those with normal pregnancies. Uterine artery pulsatility index was measured. Blood samples included serum placental growth factor and soluble fms-like tyrosine kinase-1.

Results:

A total of 4,795 pregnancies were studied, and 126 (2.6%) developed preeclampsia. At midgestation, peripheral vascular resistance was slightly higher and cardiac indices (left ventricular global longitudinal systolic strain, ejection fraction, cardiac output, and left atrial area) were slightly lower in patients who later developed preeclampsia. The use of cardiac indices did not improve prediction of preeclampsia when used in combination with maternal risk factors, mean arterial pressure, and biomarkers of placental perfusion and function.

Conclusions:

Preeclampsia and gestational hypertension are associated with early findings of increased peripheral vascular resistance. The addition of cardiac indices measured by echocardiography at midgestation did not improve prediction of preeclampsia.

Perspective:

Preeclampsia carries short- and long-term cardiovascular risk. Prior studies have associated preeclampsia with acute changes in cardiac function, particularly diastolic dysfunction. Long-term follow-up after preeclampsia shows persistent adverse cardiac remodeling. This study assessed cardiac function prior to the development of preeclampsia. Although measures of cardiac function were slightly lower among patients with preeclampsia, differences were small and possibly not clinically significant, particularly after accounting for multiple testing. When added to existing predictors of preeclampsia, cardiac indices as measured by echocardiography in midgestation (around 20 weeks) were not effective for predicting subsequent development of preeclampsia.

Keywords: Biomarkers, Cardiac Output, Diagnostic Imaging, Echocardiography, Hypertension, Pregnancy-Induced, Perfusion, Placenta Growth Factor, Pre-Eclampsia, Pregnancy, Risk Factors, Secondary Prevention, Stroke Volume, Vascular Endothelial Growth Factor Receptor-1, Vascular Resistance, Ventricular Function, Left, Ventricular Remodeling, Women


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