Decreased endothelial function and increased subclinical heart failure in women several years after pre‐eclampsia

Breetveld, N. M.; Ghossein‐Doha, Chahinda; Neer, J. van; Sengers, M. J. J. M.; Geerts, L.; Kuijk, Sander M. J. van; Dijk, Arie P.J. van; Vlugt, Maureen J. van der; Heidema, Wieteke M.; Rocca, Hans‐Peter Brunner‐La; Scholten, Ralph R.; Spaanderman, Marc E. A.

doi:10.1002/uog.17534

Cited by 30 publications

(22 citation statements)

References 58 publications

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“…Breetveld et al in their prospective longitudinal cohort study confirmed that the prevalence of HF-B was consistently high (1 in 4) amongst formerly PE women at 1 and 4 years postpartum (41). Moreover, in a subsequent observational case-control study, he confirmed that the prevalence of HF-B in formerly PE women was threefold higher than that detected for healthy parous controls (25 vs. 8%, P < 0.05) at more than 4 years post-partum (47). The increased risk of asymptomatic HF in formerly PE women was further confirmed by Ghossein-Doha et al who also found that prehypertension increased this risk significantly, while metabolic syndrome elements did not (42).…”

Section: Asymptomatic Heart Failurementioning

confidence: 79%

Hypertensive Disorders of Pregnancy and Future Cardiovascular Health

Melchiorre

Thilaganathan

Giorgione

et al. 2020

Front. Cardiovasc. Med.

100

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Hypertensive disorders of pregnancy (HDP) occur in almost 10% of gestations. These women are known to have higher cardiovascular morbidity and mortality later in life in comparison with parous controls who had normotensive pregnancies. Several studies have demonstrated that women with preeclampsia present in a state of segmental impaired myocardial function, biventricular chamber dysfunction, adverse biventricular remodeling, and hypertrophy, a compromised hemodynamic state and indirect echocardiographic signs of localized myocardial ischemia and fibrosis. These cardiac functional and geometric changes are known to have strong predictive value for cardiovascular disease in non-pregnant subjects. A "dose effect" response seems to regulate this relationship with severe HDP, early-onset HDP, coexistence of fetal growth disorders, and recurrence of HDP resulting in poorer cardiovascular measures. The mechanism underlying the relationship between HDP in younger women and cardiovascular disease later in life is unclear but could be explained by sharing of pre-pregnancy cardiovascular risk factors or due to a direct impact of HDP on the maternal cardiovascular system conferring a state of increased susceptibility to future metabolic or hemodynamic insults. If so, the prevention of HDP itself would become all the more urgent. Shortly after delivery, women who experienced HDP express an increased risk of classic cardiovascular risk factors such as essential hypertension, renal disease, abnormal lipid profile, and diabetes with higher frequency than controls. Within one or two decades after delivery, this group of women are more likely to experience premature cardiovascular events, such as symptomatic heart failure, myocardial ischemia, and cerebral vascular disease. Although there is general agreement that women who suffered from HDP should undertake early screening for cardiovascular risk factors in order to allow for appropriate prevention, the exact timing and modality of screening has not been standardized yet. Our findings suggest that prevention should start as early as possible after delivery by making the women aware of their increased cardiovascular risk and encouraging weight control, stop smoking, healthy diet, and daily exercise which are well-established and cost-effective prevention strategies.

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Section: Asymptomatic Heart Failurementioning

confidence: 79%

Hypertensive Disorders of Pregnancy and Future Cardiovascular Health

Melchiorre

Thilaganathan

Giorgione

et al. 2020

Front. Cardiovasc. Med.

100

View full text Add to dashboard Cite

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“…Women who develop PE have prepregnancy cardiovascular risk factors, demonstrating increased arterial stiffness and impaired cardiac function at the time of the clinical diagnosis, as well as several weeks before clinical onset of the pathology and several months after the index pregnancy. The cardiovascular implications of PE appear to continue long‐term, as shown both by increased frequency of prolonged subclinical impairment of systolic biventricular and endothelial function, and by the increased risk of cardiovascular morbidity later in life. The hazard ratio for developing cardiovascular disease later in life is as high as 5.4 in women who had severe PE/eclampsia.…”

Section: Assessment Of Maternal Hemodynamicsmentioning

confidence: 99%

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

Sotiriadis

Hernández‐Andrade

Costa

et al. 2018

Ultrasound in Obstet & Gyne

143

115

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RESUMEN Pautas de práctica de ISUOG: la función del ultrasonido en la detección y seguimiento de la preeclampsia Introducción La hipertensión en el embarazo afecta hasta el 10% de las mujeres embarazadas y la incidencia global combinada de la preeclampsia (PE) es de aproximadamente el 3%. Las diferencias significativas entre los países desarrollados y en desarrollo pueden atribuirse a diferencias reales o a diferencias derivadas de la adquisición de datos. La PE y sus complicaciones contribuyen en gran medida a la morbilidad y mortalidad materna y perinatal en todo el mundo. Dado que la atención oportuna y efectiva puede mejorar los resultados de la PE, el desarrollo de estrategias eficaces de predicción y prevención ha sido uno de los principales objetivos de la atención prenatal y de la investigación. La PE es una enfermedad multisistémica de origen multifactorial: está relacionada con placentación defectuosa, estrés oxidativo, autoinmunidad, activación de plaquetas y trombina, inflamación intravascular, disfunción endotelial, desequilibrio en la angiogénesis y mala adaptación cardíaca materna. La invasión defectuosa de la placenta está fuertemente asociada con la mayoría de los casos de PE temprana y grave. En contraste, la placentación defectuosa parece ser menos importante para el desarrollo de la PE que se manifiesta más tarde en el embarazo, por ejemplo después de las 34 semanas. En comparación con los embarazos afectados por la enfermedad de aparición temprana, en aquellos complicados con PE a término o cerca de este, la frecuencia de anomalías histológicas de las placentas es significativamente menor, y los factores maternos (p. ej. el síndrome metabólico o la hipertensión crónica) tienen una importancia relativamente mayor. También se observan diferencias entre la PE de aparición temprana y la de aparición tardía en los factores de riesgo, la capacidad de respuesta vascular materna, el rendimiento del cribado y la eficacia de la prevención. El conocimiento cada vez mayor sobre la fisiopatología de la PE se refleja en las estrategias de cribado actuales, que se basan en el historial, la demografía, los biomarcadores (como la presión arterial) y el Doppler de la arteria uterina. Actualmente hay más de 10 000 artículos de PubMed relacionados con la detección de la PE, lo que indica el gran interés en este tema. Menos de una quinta parte de estos se refieren a la detección temprana, lo que constituye un avance de la última década. El objetivo de estas Pautas es revisar la evidencia más reciente y, en lo posible, proporcionar recomendaciones basadas en la evidencia con respecto a la función del ultrasonido en el cribado y seguimiento de la PE. Las Pautas se centran en los aspectos técnicos y clínicos del cribado, sin incluir los aspectos económicos y políticos de la salud, como la conveniencia y la rentabilidad del cribado. Además, estas Pautas se elaboraron partiendo del supuesto de que se dispone de los recursos necesarios para la realización del cribado y el seguimiento (equipo, examinadores y conocimient...

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“…Next, given that women with a history of preeclampsia have an increased risk for microvascular injury and heart failure 13 , we assessed whether women with preeclampsia and asymptomatic LVDD indeed display an association with microvascular injury. To that extent we measured markers of microvascular injury in plasma from women with a previous history of pre-eclampsia and asymptomatic LVDD (n = 13, Supplemental Table 1 ) As compared to healthy controls (n = 14), our assessment of Ang-2, soluble trombomodulin (sTM) and soluble fms-like tyrosine kinase-1 (sFlt-1) revealed that only plasma Ang-2 levels were higher in women with a history of preeclampsia and asymptomatic LVDD (fold change (FC) 1.4, p = 0.02, 95% CI 230.5–1,084) (Supplemental Table 5 and Supplemental Figure 1 B).…”

Section: Resultsmentioning

confidence: 99%

“…In the main patient studies, expression of individual miRNAs was detected by dedicated TaqMan qRT-PCR assays as previously described 8 . After comparison of miR-16 en U6 Ct-values and their respective standard deviation (SD) in asymptomatic LVDD patients, LVDD patients and HFpEF patients, we choose to normalize miR expression results using expression levels of miR-16 13 .…”

Section: Adjudication Of Diagnosis Of Asymptomatic Lvdd (Maastricht Smentioning

confidence: 99%

Sex-specific microRNAs in women with diabetes and left ventricular diastolic dysfunction or HFpEF associate with microvascular injury

Florijn

Valstar

Duijs

et al. 2020

Sci Rep

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Left ventricular diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF) are microcirculation defects following diabetes mellitus (DM). Unrecognized HFpEF is more prevalent in women with diabetes compared to men with diabetes and therefore sex-specific diagnostic strategies are needed. Previously, we demonstrated altered plasma miRs in DM patients with microvascular injury [defined by elevated plasma Angiopoietin-2 (Ang-2) levels]. This study hypothesized the presence of sex-differences in plasma miRs and Ang-2 in diabetic (female) patients with LVDD or HFpEF. After a pilot study, we assessed 16 plasma miRs in patients with LVDD (n = 122), controls (n = 244) and female diabetic patients (n = 10). Subsequently, among these miRs we selected and measured plasma miR-34a,-224 and-452 in diabetic HFpEF patients (n = 53) and controls (n = 52). In LVDD patients, miR-34a associated with Ang-2 levels (R 2 0.04, R = 0.21, p = 0.001, 95% CI 0.103-0.312), with plasma levels being diminished in patients with DM, while women with an eGFR < 60 ml/min and LVDD had lower levels of miR-34a,-224 and-452 compared to women without an eGFR < 60 ml/min without LVDD. In diabetic HFpEF women (n = 28), plasma Ang-2 levels and the X-chromosome located miR-224/452 cluster increased compared to men. We conclude that plasma miR-34a,-224 and-452 display an association with the microvascular injury marker Ang-2 and are particularly targeted to women with LVDD or HFpEF. Abbreviations MiR MicroRNA HFpEF Heart failure with preserved ejection fraction HFrEF Heart failure with a reduced ejection fraction LVDD Left ventricular diastolic dysfunction DM Diabetes mellitus X-linked X-chromosome located XIST X-inactive-specific transcript Ang-2 Angiopoietin-2 sFlt-1 Plasma soluble Flt-1 sTM Plasma soluble thrombomodulin PE Preeclampsia

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Decreased endothelial function and increased subclinical heart failure in women several years after pre‐eclampsia

Abstract: Years after pregnancy, formerly pre- eclamptic women have lower FMD and have HF-B more often compared with healthy parous controls. Nonetheless, HF-B was not related to reduced FMD. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Cited by 30 publications

References 58 publications

Hypertensive Disorders of Pregnancy and Future Cardiovascular Health

Hypertensive Disorders of Pregnancy and Future Cardiovascular Health

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

Sex-specific microRNAs in women with diabetes and left ventricular diastolic dysfunction or HFpEF associate with microvascular injury

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