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Acute Cardiac Effects of Severe Pre-Eclampsia

ARTICLE: Acute Cardiac Effects of Severe Pre-Eclampsia

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

JOURNAL: J Am Coll Cardiol. 2018 Jul 3;72(1):1-11. doi: 10.1016/j.jacc.2018.04.048.


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 cardiacparameters, 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.

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Kelsey Bennett