Dynamic changes in cardiac function before and early postdelivery in women with severe preeclampsia

Abstract

Objectives: In women with severe preeclampsia the period immediately before and early postdelivery carries the greatest risk for cardiac decompensation due to acute changes in loading conditions. The authors aimed to evaluate dynamic changes in hemodynamic and echocardiographic-derived systolic and diastolic function parameters in preeclamptic women compared with healthy controls. Methods: Thirty women with severe preeclampsia and 30 healthy controls underwent transthoracic echocardiography 1 day before, 1 and 4 days postdelivery. Fluid responsiveness was assessed by passive leg raising. Results: Peak systolic myocardial velocities (s′) and global longitudinal strain (GLS) were significantly lower in preeclamptic group compared with controls only postdelivery (s′: 7.3 ± 0.8 vs. 8.3 ± 0.9 cm/s, P < 0.001; GLS: −21.4 ± 2.0 vs. −23.0 ± 1.4%, P = 0.027). In addition, significant decrease in s′ after delivery was observed only in preeclamptic group (P = 0.004). For diastolic parameters there were differences both before and postdelivery in E/e′ ratio (before: 8.4 ± 2.16 vs. 6.7 ± 1.89, P = 0.002; postdelivery: 8.3 ± 1.64 vs. 6.8 ± 1.27, P = 0.003) and mitral e′ velocity (before: 11.0 ± 2.39 vs. 12.6 ± 1.86, P = 0.004; postdelivery: 11.1 ± 2.28 vs. 14.0 ± 2.40 cm/s, P < 0.001). Significant increase in left ventricular stroke volume (P = 0.005) and transmitral E velocity (P = 0.003) was observed only in control group, reflecting response to volume load after delivery. Accordingly, only the minority of preeclamptic women were fluid responsive (11 vs. 43%, P = 0.014 between groups). Conclusion: Variations in cardiac parameters in healthy women seem to follow changes in loading conditions before and early after delivery. Different pattern in preeclamptic women, however, may be related to subtle myocardial dysfunction, that becomes uncovered with augmented volume load in early postpartum period.

Value of Ultrasonic Image Features in Diagnosis of Perinatal Outcomes of Severe Preeclampsia on account of Deep Learning Algorithm

“…DV was a blood vessel from the fetal umbilical portal sinus and inferior vena cava to the right atrium. Abnormal DV could reflect the pressure changes between the fetal UV and right atrium [22]. In this study, it was observed that DV-PIV and DV-PVIV in the adverse outcome group were significantly higher than those in the good outcome group, which was speculated to be caused by the proliferation of smooth muscle cells in the uterine spiral artery of pregnant women in presevere epilepsy, resulting in arterial luminal stenosis, which reduced UTA blood supply, decreased UA blood flow, and increased DV blood flow parameters.…”

Peripartum echocardiographic changes in women with hypertensive disorders of pregnancy

“…The findings of this study should be considered carefully as the comparison of cardiac geometry before delivery between these two groups was not in agreement with previous literature 3 . They showed that only normal pregnancies were able to respond in the immediate postpartum period by significantly increasing SV and transmitral E velocity compared to preeclamptic patients 27 . This difference in response could be explained by the fact that the maternal heart in hypertensive disorders is not capable of increasing SV with increased preload because of impaired LV function 2,28 .…”

“…This is consistent with the finding that a significant proportion of women with an apparently normal pregnancy had diastolic dysfunction and abnormal cardiac remodeling at term as signs of cardiovascular maladaptation to the volume-overloaded state 26 . Ambrozic et al 27 compared echocardiographic findings between 30 women with severe PE and 30 healthy controls who underwent TTE 1 day before and 1 and 4 days after delivery. The findings of their study should be considered carefully, as the comparison of cardiac geometry before delivery between these two groups was not in agreement with previous literature 3 .…”

Myocardial Mechanics in Hypertensive Disorders of Pregnancy: a Systematic Review and Meta-Analysis

“…For those articles in which information was not reported but the methodology indicates that this information would have been recorded initially, the authors were contacted. [17][18][19]…”