Maternal Cardiac Dysfunction and Remodeling in Women With Preeclampsia at Term

TLDR

Preeclampsia is linked to significant cardiovascular morbidity during pregnancy and later life, with diastolic dysfunction often preceding systolic dysfunction and serving as a prognostic marker for long‑term cardiovascular risk. This study evaluated cardiac function and remodeling in women with term preeclampsia. A prospective case‑control study of 50 term preeclamptic and 50 normal pregnancies used echocardiography and tissue Doppler analysis. Term preeclampsia was associated with more frequent global diastolic dysfunction (40% vs 14%), increased cardiac work and left‑ventricular mass indices indicating adaptive remodeling, about 20% of patients showing myocardial damage, and these findings have implications for acute medical management.

Abstract

Preeclampsia is a disease associated with significant cardiovascular morbidity during pregnancy and in later life. This study was designed to evaluate cardiac function and remodeling in preeclampsia occurring at term. This was a prospective case-control study of 50 term preeclampsia and 50 normal pregnancies assessed by echocardiography and tissue Doppler analysis. Global diastolic dysfunction was observed more frequently in preeclampsia versus control pregnancies (40% versus 14%, P = 0.007). Increased cardiac work and left ventricular mass indices suggest that left ventricular remodeling was an adaptive response to maintain myocardial contractility with preeclampsia at term. Approximately 20% of patients with preeclampsia at term have more evident myocardial damage. Diastolic dysfunction usually precedes systolic dysfunction in the evolution of ischemic or hypertensive cardiac diseases and is of prognostic value in the prediction of long-term cardiovascular morbidity. The study findings also have significant implications for the acute medical management of preeclampsia.