Maternal cardiovascular dysfunction in women with early onset preeclampsia: a cross-sectional study

Abstract

Background

Cardiac remodeling and diastolic dysfunction may occur, in women with early-onset preeclampsia, following raised total vascular resistance in response to the impaired placentation. These changes can increase the risk of premature cardiac morbidity and mortality later in life. According to updated guidelines by the American and European Societies of Echocardiography (ASE/ESE) to diagnose diastolic dysfunction, using a simpler criterion is not yet used in pregnant women.

Objective

To compare the maternal cardiovascular changes and the variation in the diastolic dysfunction using the 2009 and 2016 criteria by ASE/ESE among women with early onset preeclampsia and gestational age-matched normotensive controls.

Methods

A prospective matched cross-sectional study conducted in a tertiary hospital in South India, involving 40 women with early and 40 women with gestational age-matched normotensive controls. Cardiac function and remodeling were assessed by conventional 2D, M-mode, and Doppler echocardiography.

Results

Compared to the controls, women with early-onset preeclampsia had significantly higher. Total vascular resistance index (2867.6 vs. 2277.2 dynes/s/cm⁵/m², p = .035) and median end-systolic stress index (5.2 vs. 9.2 dyne/cm²/m²), suggesting a higher afterload. Cases had a significant rate of left ventricular diastolic dysfunction using the 2009 criteria (grade II/III: 21 (52%) vs. 0 (0%), p<.001) whereas the rates were much lower when the updated 2016 guidelines were used (grade II/III: 9 (22.5%) vs. 1 (2.5%), p<.001).

Conclusions

In women with early-onset preeclampsia, cardiovascular adaption occurs to minimize wall stress and myocardial oxygenation. The prevalence of diastolic dysfunction was observed to be lower with the 2016 criteria. Further studies involving pregnant women are required to assess the impact of newer guidelines on association with short- and long-term cardiovascular outcomes in high-risk women.

Keywords:

• Cardiovascular dysfunction
• echocardiography
• early-onset preeclampsia
• pregnancy
• diastolic dysfunction

Acknowledgments

Ethical approval: This study was done as per the Institute Scientific Advisory and Ethical Committee (Human Studies), following the 1964 Helsinki Declaration and its later amendments. The protocol was approved by the Institute Ethics Committee (Human Studies) (approval number: JIP/IEC/2014/5/315 dated 5 September 2014).

Authors contributions

AAP and AK conceived the study. All authors contributed to the design. DKS, MT, BPP, and KP carried out the investigation under the supervision of AK and AAP. MT and KP performed the data collection and guarantee data integrity. AK performed statistical analyses. AAP, DKS, MT, BPP, and KP reviewed the analysis and AK, MT, and KP wrote the first draft. All authors contributed to revising and finalization of the manuscript. AK (corresponding author) guarantees all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Disclosure statement

The authors have no conflicts of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author, (AK), upon reasonable request.