Abnormal mid-trimester cardiac strain in women with chronic hypertension predates superimposed preeclampsia

Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders

“…209,210 Because GLS differentiates active from passive contraction and is less sensitive to loading conditions than ejection fraction, it reliably detects the early onset of subclinical systolic heart failure in patients with PE. 195,209,211,212 PE is also identified as a major risk factor for peripartum cardiomyopathy. 213,214 In patients with preserved ejection fraction, GLS is sensitive to detect early subclinical cardiomyopathy before a decline in ejection fraction.…”

Maternal cardiac function at 19–23 weeks' gestation in prediction of pre‐eclampsia

“…Several cross‐sectional and cohort studies have demonstrated consistently that women with established PE, compared to those with normotensive pregnancy, have impaired cardiac function 1–13 and are twice as likely to develop future ischemic heart disease 33 . A few studies in high‐risk pregnancies have shown that cardiac dysfunction precedes the development of PE 14–17 , suggesting that PE is acting as a marker of a woman's chronic underlying susceptibility to future disease rather than causing harm to the maternal cardiovascular system. Vasapollo et al .…”

“…Shahul et al . examined 60 women with chronic hypertension at 20 weeks' gestation and reported that, in the group of 34 women with abnormal global longitudinal strain, there was a significantly higher incidence of subsequent development of superimposed PE 17 . There is one previous screening study in an unselected population; in this study, we examined 1602 women with singleton pregnancy at 35–37 weeks' gestation and showed that women who subsequently developed PE, compared to those who remained normotensive, had distinct cardiac functional and structural changes and that cardiac assessment could offer incremental prognostic value to available scoring systems for the development of term PE 34 .…”

“…Several cross-sectional and cohort studies have demonstrated consistently that women with established PE, compared to those with normotensive pregnancy, have impaired cardiac function [1][2][3][4][5][6][7][8][9][10][11][12][13] and are twice as likely to develop future ischemic heart disease 33 . A few studies in high-risk pregnancies have shown that cardiac dysfunction precedes the development of PE [14][15][16][17] , suggesting that PE is acting as a marker of a woman's chronic underlying susceptibility to future disease rather than causing harm to the maternal cardiovascular system. one previous screening study in an unselected population; in this study, we examined 1602 women with singleton pregnancy at 35-37 weeks' gestation and showed that women who subsequently developed PE, compared to those who remained normotensive, had distinct cardiac functional and structural changes and that cardiac assessment could offer incremental prognostic value to available scoring systems for the development of term PE 34 .…”

“…Maternal echocardiographic studies have demonstrated that, in women with pre-eclampsia (PE), compared to normotensive controls, there is evidence of impaired myocardial function and increased peripheral vascular resistance [1][2][3][4][5][6][7][8][9][10][11][12][13] . A few studies in high-risk pregnant women have demonstrated that hemodynamic and subclinical cardiac dysfunction may precede the onset of PE [14][15][16][17] .…”