Cardiovascular haemodynamics in pre-eclampsia using brain naturetic peptide and tissue Doppler studies : cardiovascular topics

Abstract

AimTo determine early haemodynamic changes in pre-eclampsia (PE) using tissue Doppler echocardiography and brain natriuretic peptide (BNP), and to relate these changes to obstetric outcomes.MethodsConsenting primigravidae patients in the third trimester of pregnancy were included in the study, which was carried out in a large regional hospital in Durban, South Africa; 115 primigravidae (52 pre-eclamptics and 63 normotensive pregnant patients) attending the maternity unit including the antenatal clinics at the study site were studied. The patients, matched for maternal and gestational age, were examined during pregnancy and within the puerperium. Transthoracic echocardiography (TTE), tissue Doppler imaging (TDI), umbilical artery Doppler and laboratory investigations were performed.ResultsBNP levels were significantly increased in the antepartum period [23.8 (2–184.1) vs 6.0 (0.5–45.2) pmol/l; p < 0.0001] and during labour [15.0 (1.8–206.4) vs 8.7 (1.9–24.8) pmol/l; p < 0.01] in the pre-eclamptic group compared to the normotensive controls. In the postpartum period, mean BNP levels were 4.2 (1.7–51.4) and 5.95 (2.2–38.7) pmol/l in the pre-eclamptic and normotensive groups, respectively (p > 0.05). Tissue Doppler Em/Ea ratios were elevated in the pre-eclamptic compared to the normotensive group (11.02 ± 5.6 vs 9.16 ± 2.6; p < 0.05). Mean left atrial size was larger (38 mm) in the pre-eclamptic group than in the normotensive group (35 mm) but this difference was not significant (p > 0.05).The umbilical artery resistance index was significantly higher in the pre-eclamptic group compared to the normotensive group (0.68 ± 0.06 vs 0.63 ± 0.05; p < 0.001). There was an increased rate of Caesarean sections performed in the pre-eclamptic group (n = 24) compared to the normotensive group (n = 18; p < 0.001). There were two stillbirths in the pre-eclamptic group and none in the normotensive group. As expected, birth weight (2.6 ± 0.8 kg vs 3.14 ± 0.42 kg; p < 0.0001) was lower in the pre-eclamptic group compared to the normotensive group.ConclusionIn pregnancies complicated by pre-eclampsia, BNP levels were increased in comparison to normotensive pregnancies and this was accompanied by early changes in left ventricular diastolic function as determined by the tissue Doppler Em/Ea ratios. These changes reverted to baseline values, as indicated by return of BNP levels in the pre-eclamptic group to levels seen in the normotensive group. These changes were associated with an increased Caesarean section rate and lower birth weights in pre-eclamptic mothers.

Postpartum evaluation of cardiovascular disease risk for women with pregnancies complicated by hypertension

“…[9] However, there are conflicting studies of natriuretic peptide concentrations in postpartum studies with some reporting elevated NT-pro-BNP concentrations in women with previous pre-eclampsia at three to six months postpartum compared to women with non-complicated pregnancies [25] and others reporting no difference in BNP concentrations between women with previous pre-eclampsia and healthy controls at one to four weeks postpartum. [26,27] Postpartum comparison of BNP concentrations between women with pre-eclampsia and pre-existing chronic hypertension has not previously been reported, and no differences were identified in this study. The absence of any association between BNP concentration and future CVD risk suggests that this marker is unlikely to have any useful predictive value in clinical practice.…”

Shared biomarkers between female diastolic heart failure and pre‐eclampsia: a systematic review and meta‐analysis

“…Seven studies reported on BNP levels,78, 79, 80, 81, 82, 83, 84 of which three were applicable for a meta‐analysis ( Figure 5). 78, 79, 80 …”

“…One study reported on FABP4 levels in pre-eclampsia compared with controls and found statistically higher FABP4 levels in pre-eclampsia vs. non-hypertensive pregnancy. 77 Myocardial failure markers in pre-eclampsia Brain natriuretic peptide and N-terminal pro-BNP Seven studies reported on BNP levels, [78][79][80][81][82][83][84] of which three were applicable for a meta-analysis ( Figure 5). [78][79][80] In all seven studies and in meta-analysis, BNP levels were significantly higher in pre-eclampsia than in controls.…”

Maternal cardiac function, uterine artery hemodynamics and natriuretic peptides at 22‐24 weeks of gestation and subsequent development of hypertensive disorders of pregnancy

“…This increase has been attributed to a rise in the tissue Doppler early filling wave (E′) and has been suggested to reflect rising cardiac filling pressures in preeclampsia. 38 However, it has been shown that preeclamptic women are preload responsive, ie, they increase their CO in response to volume load. 33,39 Although in clinical practice, pulmonary artery occlusion pressure is considered to reflect preload (pressure is easier to assess than the flow and volume), preload is related to filling blood volume rather than the filling pressure, and left atrial and ventricular pressures are a function of blood inflow and chamber compliance.…”