Severe preeclampsia carries cardiac, vascular consequences
Women with severe preeclampsia had elevated right ventricular systolic pressure, high rates of diastolic dysfunction, high risk for pulmonary edema and other adverse parameters, researchers reported.
For a prospective, observational study, the researchers analyzed 63 women with preeclampsia with severe features and 36 healthy pregnant women.
Outcomes of interest included RV systolic pressure and various echocardiographic measures.
Compared with healthy controls, women with severe preeclampsia had elevated RV systolic pressure (31 mm Hg vs. 22.5 mm Hg; P < .001) and reduced global RV longitudinal systolic strain (–19.6 vs. –23.8; P < .0001), Arthur Jason Vaught, MD, from the department of gynecology and obstetrics, Johns Hopkins University School of Medicine, and colleagues wrote.
The researchers also observed differences in the following left-sided cardiac parameters (P < .001 for all):
- mitral septal e’ velocity: preeclampsia group, 9.6 cm per second; controls, 11.6 cm per second;
- septal E/e’ ratio: preeclampsia group, 10.8; controls, 7.4;
- left atrial area size: preeclampsia group, 20.1 cm2; controls, 17.3 cm2;
- median posterior wall thickness: preeclampsia group, 1 cm; controls, 0.8 cm; and
- median septal wall thickness: preeclampsia group, 1 cm; controls, 0.8 cm.
In the preeclampsia cohort, 12.7% had grade II diastolic dysfunction and 9.5% had peripartum pulmonary edema, according to the researchers.
“All the women who developed pulmonary edema had abnormally elevated septal E/e’ ratios, which suggests high LV filling pressures and diastolic dysfunction,” Vaught and colleagues wrote. “Our findings suggest that greater use of echocardiography in patients with severe preeclampsia may help identify particularly high-risk women and help improve clinical outcomes.”
The study “has highlighted again in an elegant way the occult aberrant cardiac adaptation during severe preeclampsia and shows that not only LV diastolic and systolic function may be impaired, but for the first time, also impaired RV longitudinal systolic strain,” Chahinda Ghossein-Doha, MD, PhD, from the department of cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands, and colleagues wrote in a related editorial. “It supports the concept that pregnancy should be valued as a sex-specific, women-sensitive CV stress test, and the necessity to use novel methods in order to detect early stage abnormalities in the twilight zone between health and disease.” – by Erik Swain
Disclosures: The study and editorial authors report no relevant financial disclosures.