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Observational Study
. 2018 Jul 3;72(1):1-11.
doi: 10.1016/j.jacc.2018.04.048.

Acute Cardiac Effects of Severe Pre-Eclampsia

Arthur Jason Vaught  1 , Lara C Kovell  2 , Linda M Szymanski  3 , Susan A Mayer  4 , Sara M Seifert  5 , Dhananjay Vaidya  4 , Jamie D Murphy  6 , Cynthia Argani  3 , Anna O'Kelly  7 , Sarah York  4 , Pamela Ouyang  4 , Monica Mukherjee  4 , Sammy Zakaria  4
Affiliations
Observational Study

Acute Cardiac Effects of Severe Pre-Eclampsia

Arthur Jason Vaught et al. J Am Coll Cardiol. .

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.

Keywords: diastolic dysfunction; echocardiography; pre-eclampsia; pulmonary edema; right ventricular systolic pressure; speckle tracking echocardiography.

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Figures

CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Pre-Eclampsia With Severe Features: Effects on the Heart
The effects of pre-eclampsia with severe features (PEC) on the heart. LV = left ventricle; RVLSS = right ventricular longitudinal systolic strain; RVSP = right ventricularsystolic pressure.
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