Ophthalmic artery peak systolic velocity ratio distinguishes pre‐eclampsia from chronic and gestational hypertension: A prospective cohort study

Abstract

Objective: To examine whether the ophthalmic artery peak systolic velocity ratio (OA PSV-ratio) is higher in women with pre-eclampsia compared with gestational hypertension (GH) and chronic hypertension (CH), after controlling for confounding variables. Design: Prospective cohort.Setting: Specialist hypertension clinic in a tertiary referral centre.Population: Singleton pregnancies presenting between 32 +0 and 36 +6 weeks of gestation with pre-eclampsia (n = 50), GH (n = 54) and CH (n = 56).Methods: Paired measurements of maternal mean arterial pressure (MAP) and OA PSV-ratio were performed by trained sonographers. Multiple linear regression was fitted to the OA PSV-ratio, including maternal characteristics and medical history, GH, pre-eclampsia and MAP and use of antihypertensive medication.Main Outcome Measure: Whether pre-eclampsia is independently associated with higher OA PSV-ratio.Results: MAP was significantly higher in both GH (p = 0.0015) and pre-eclampsia (p = 0.008) than in CH pregnancies. There was no significant difference between pre-eclampsia and GH (0.670). The OA PSV-ratio was significantly higher in preeclampsia than CH (p = 0.0008) and GH (p = 0.015). There was no significant difference between the OA PSV-ratio in CH and GH (p = 0.352). Multiple linear regression modelling showed that the OA PSV-ratio was influenced by maternal weight (p = 0.005), maternal age (p = 0.014), antihypertensive medications (p = 0.007) and MAP (p < 0.0001). After controlling for these variables, the OA PSV-ratio was still significantly higher in those with pre-eclampsia (p = 0.0002). Conclusions:The OA PSV-ratio is influenced by maternal weight, age, antihypertensive medications and MAP. Pre-eclampsia is an independent predictor of OA PSV-ratio, which therefore may be a useful point-of-care test when assessing women presenting with hypertension.

Ophthalmic artery Doppler in hypertensive pregnancies: Small vessel, many possibilities

“…In this context, our team analysed OAD waveforms in 70 pregnant smokers and found an important modulation caused by cigarette use: a biphasic pattern of perfusion correlated with the time since the consumption of the last cigarette. This study is in agreement with that of Lau et al, 1 which also demonstrates that it is possible to perform non-invasive assessment of central nervous system arteries in pregnant women and test the action of vasoactive drugs. 4 We have also reported the accuracy and best cutoff value for OAD indices to diagnose pre-eclampsia.…”

“…Ophthalmic artery Doppler in hypertensive pregnancies: Small vessel, many possibilities Dear Dr. Papageorghiou, We read with great interest the study by Lau et al, 1 and the excellent mini-commentary published by Gonser et al, 2 where we had the honour to be cited in the Acknowledgments. This motivated us to write a brief comment on the use of ophthalmic artery Doppler (OAD).…”

Ophthalmic artery Doppler as a marker of pre‐eclampsia: Why does it work?

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We thank Diniz and Paes for their letter 1 on our minicommentary 2 regarding the study by Lau et al 3 In that letter they talk about their recently published study highlighting the potential of ophthalmic artery (OA) Doppler as a complementary diagnostic tool of pre-eclampsia (PE). 4 The best diagnostic performance showed the 2nd systolic peak P2 and in particular the systolic peak ratio PR = P2/P1.

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Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative study

“…However, screening studies showed that assessment of these indices offers no significant benefit to routine screening which uses maternal characteristics to identify women at risk of HDP 7 . In contrast, impedance to peripheral blood flow assessed by ophthalmic artery Doppler can identify women at risk of HDP in all three trimesters of pregnancy 9–11 . Whether these findings suggest more established vascular disease in women at risk of HDP remains to be determined.…”