Acute Cardiac Effects of Severe Pre-Eclampsia

Vaught, Arthur J.; Kovell, Lara C.; Szymanski, Linda M.; Mayer, Susan A.; Seifert, Sara M.; Vaidya, Dhananjay; Murphy, Jamie D.; Argani, Cynthia; O’Kelly, Anna C.; York, Sarah; Ouyang, Pamela; Mukherjee, Monica; Zakaria, Sammy

doi:10.1016/j.jacc.2018.04.048

Cited by 144 publications

(103 citation statements)

References 52 publications

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“…Assessment of cardiac function to better identify women who are at risk of pulmonary edema is not entirely without biological plausibility because recent evidence suggests women who develop pulmonary edema have impaired diastolic dysfunction. 68,93 Major complications of preeclampsia, such as pulmonary edema, eclampsia, and cerebrovascular incidents, are fortunately rare but often have devastating maternal sequelae. These severe complications of preeclampsia are often preventable with adequate blood pressure control, appropriate fluid management, and magnesium sulfate prophylaxis.…”

Section: Putative Roles For Cardiovascular Assessment In the Managemementioning

confidence: 99%

Cardiovascular System in Preeclampsia and Beyond

2019

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Section: Putative Roles For Cardiovascular Assessment In the Managemementioning

confidence: 99%

Cardiovascular System in Preeclampsia and Beyond

2019

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“…At the clinical onset of preeclampsia, significant hemodynamic impairment, such as lower cardiac output, abnormal ventricular geometry, and diastolic dysfunction have been demonstrated by several maternal echocardiography studies [49,56,57,58]. Severe preterm disease is associated with a worse cardiovascular profile, which is in turn associated with higher rates of serious peripartum complications, such as pulmonary edema [59,60,61]. In keeping with these findings, a number of cardiovascular biomarkers, such as ANP-related proteins and Corin, have been shown to be altered in pregnancy in women with preeclampsia [61,62,63].…”

Section: Evidence For Cardiovascular Origins Of Preeclampsiamentioning

confidence: 99%

Preeclampsia: The Relationship between Uterine Artery Blood Flow and Trophoblast Function

Ridder

Giorgione

Khalil

et al. 2019

IJMS

152

101

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Maternal uterine artery blood flow is critical to maintaining the intrauterine environment, permitting normal placental function, and supporting fetal growth. It has long been believed that inadequate transformation of the maternal uterine vasculature is a consequence of primary defective trophoblast invasion and leads to the development of preeclampsia. That early pregnancy maternal uterine artery perfusion is strongly associated with placental cellular function and behaviour has always been interpreted in this context. Consistently observed changes in pre-conceptual maternal and uterine artery blood flow, abdominal pregnancy implantation, and late pregnancy have been challenging this concept, and suggest that abnormal placental perfusion may result in trophoblast impairment, rather than the other way round. This review focuses on evidence that maternal cardiovascular function plays a significant role in the pathophysiology of preeclampsia.

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“…Despite widespread consensus that pre-eclampsia is a predominant placental disorder (associated with abnormal uteroplacental flow patterns), maladaptation of the maternal cardiovascular system to pregnancy might be the primary mechanism leading to placental dysfunction [27]. Interestingly in women with pre-eclampsia, both RV dysfunction and abnormal maternal venous hemodynamics have been shown [30,31]. These changes may lead to further increased venous pressure on the placenta which might impair trophoblast invasion resulting in abnormal placentation, as previously postulated by Gyselaers et al [32] These data support the view that venous congestion, a typical consequence of RV dysfunction, is a critical factor in the relation between the heart and placental dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot

Siegmund

Willems

Pieper

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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Background: Maternal right ventricular (RV) dysfunction (measured by echocardiography) is associated with impaired uteroplacental circulation, however echocardiography has important limitations in the assessment of RV function. We therefore aimed to investigate the association of pre-pregnancy RV and left ventricular (LV) function measured by cardiovascular magnetic resonance with uteroplacental Doppler flow parameters in pregnant women with repaired Tetralogy of Fallot (ToF). Methods: Women with repaired ToF were examined, who had been enrolled in a prospective multicenter study of pregnant women with congenital heart disease. Clinical data and CMR evaluation before pregnancy were compared with uteroplacental Doppler parameters at 20 and 32 weeks gestation. In particular, pulsatility index (PI) of uterine and umbilical artery were studied. Results: We studied 31 women; mean age 30 years, operated at early age. Univariable analyses showed that reduced RV ejection fraction (RVEF; P = 0.037 and P = 0.001), higher RV end-systolic volume (P = 0.004) and higher LV end-diastolic and end-systolic volume (P = 0.001 and P = 0.003, respectively) were associated with higher uterine or umbilical artery PI. With multivariable analyses (corrected for maternal age and body mass index), reduced RVEF before pregnancy remained associated with higher umbilical artery PI at 32 weeks (P = 0.002). RVEF was lower in women with high PI compared to women with normal PI during pregnancy (44% vs. 53%, p = 0.022). LV ejection fraction was not associated with uterine or umbilical artery PI. Conclusions: Reduced RV function before pregnancy is associated with abnormal uteroplacental Doppler flow parameters. It could be postulated that reduced RV function on pre-pregnancy CMR (≤2 years) is a predisposing factor for impaired placental function in women with repaired ToF.

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Acute Cardiac Effects of Severe Pre-Eclampsia

Abstract: 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.

Cited by 144 publications

References 52 publications

Cardiovascular System in Preeclampsia and Beyond

Cardiovascular System in Preeclampsia and Beyond

Preeclampsia: The Relationship between Uterine Artery Blood Flow and Trophoblast Function

Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot

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