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Pre-pregnancy cardiac dysfunction may identify risk for recurrent preeclampsia, future CVD
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Evidence of diastolic and systolic dysfunction and elevated total vascular resistance in the nonpregnant state may predict a woman’s risk for recurrent preeclampsia and future CVD.
“Women who have early preeclampsia in their first pregnancy should be informed of their risk and should be carefully followed,” Herbert Valensise, MD, PhD, associate professor of obstetrics and gynecology at Tor Vergata University School of Medicine, Rome, said in a press release.
Valensise and colleagues enrolled 75 normotensive women with previous preeclampsia and 147 women who had an uneventful first pregnancy in a case-control study conducted at an outpatient clinic of Tor Vergata University. Each woman underwent echocardiographic examination 12 to 18 months after the first pregnancy. The patients then became pregnant again within 24 months of the echocardiogram and were followed throughout the new pregnancy. Those who did not exhibit signs of preeclampsia early in their new pregnancy underwent another echocardiographic examination at 24 weeks. The duration of the study was 5 years, from 2009 to 2014.
Twenty two of the 75 women with previous preeclampsia were diagnosed with early preeclampsia during the second pregnancy. The researchers categorized those who had an uncomplicated pregnancy as well as the four patients who developed gestational hypertension after 35 weeks and the one patient with fetal growth restriction who delivered at 38 weeks into the nonrecurrent preeclampsia group. The 147 women in the control group did not experience any complications in their second pregnancy.
Women with recurrent preeclampsia had distinct cardiac dysfunction compared with the control and nonrecurrent preeclampsia groups, including lower stroke volume (63 14 mL vs. 73 12 mL vs. 70 11 mL, respectively; P < .05), lower cardiac output (4.6 1.2 L vs. 5.3 0.9 L vs. 5.2 1 L; P < .05), higher diastolic BP (77 11mm Hg vs. 68 10 mm Hg vs. 69 13 mm Hg; P < .05) and elevated total vascular resistance (1,638 261 dyne·s-1·cm-5 vs. 1,341 270 dyne·s-1·cm-5 vs. 1,383261 dyne·s-1·cm-5; P < .05). A higher left ventricular mass index was measured in both the recurrent and nonrecurrent preeclampsia groups (30 6.3 g/m2.7 vs. 30.6.8 g/m2.7 vs. 24.8 5 g/m2.7; P < .05). In addition, the ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E’ ratio) was higher for those with recurrent preeclampsia (11.02 3.43 vs. 7.342.11 vs. 9.03 3.43; P < .05).
The researchers concluded that these data confirm “the strong relationship between the recurrence of preeclampsia and a possible pregestational asymptomatic predisposition characterized by a vascular maladaptation, and a cardiac systolic and diastolic dysfunction.”
“Physicians have to look at the complicated pregnancy history as a potential risk factor for [CV] complications later in life, and in a subsequent pregnancy,” Valensise stated in the release.
D isclosure: The researchers report no relevant financial disclosures
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