Subscribe to RSS
Severe Preeclampsia is Associated with Functional and Structural Cardiac Alterations: A Case-control Study
Background The aim of the current study is to compare electrocardiographic and echocardiographic changes in patients with severe preeclampsia (PE) and those with uncomplicated pregnancies.
Methods This is a case-controlled prospective study consisting of 21 pregnant women with severe preeclampsia and a control group consisting of age- and gestational age-matched 24 healthy pregnant women. All patients underwent electrocardiographic and echocardiographic investigation.
Results QRS intervals were shorter and PR intervals were longer in the PE group (QRS duration: 80 (60–120) ms and 80 (40–110) ms, p=0.035; PR duration: 160 (100–240) ms and 120 (80–200) ms, respectively; p=0.046). The left ventricular end-systolic diameters of the patients with severe PE group were significantly larger than the control group (31 (24–36) mm and 30 (24–33) mm, respectively; p=0.05). Similarly, posterior wall thickness values of the PE group were significantly higher compared to the control group (9 (7–11) mm vs. 8 (6–10) mm, respectively; p=0.020). Left ventricular mass (146.63±27.73 g and 128.69±23.25 g, respectively; p=0.033) and relative wall thickness values (0.385±0.054 and 0.349±0.046, respectively; p=0.030) were also higher in the PE group. In addition, patients with early-onset severe PE had significantly a higher left ventricular end-diastolic diameter and volume compared with late-onset PE patients.
Conclusions The structural changes detected in the severe PE group suggest a chronic process rather than an acute effect. In addition, diastolic dysfunction and left ventricular remodeling are most marked in patients with severe early-onset PE.
Key wordsSevere preeclampsia - Cardiovascular risk - Echocardiography - Electrocardiography - Hemodynamics - Pregnancy
Received: 16 November 2020
Accepted after revision: 20 February 2021
09 April 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Abalos E, Cuesta C, Grosso AL. et al. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol 2013; 170: 1-7
- 2 Lisonkova S, Sabr Y, Mayer C. et al. Maternal morbidity associated with early-onset and late-onset preeclampsia. Obstet Gynecol 2014; 124: 771-781
- 3 Roberts JM, Escudero C. The placenta in preeclampsia. Pregnancy Hypertens 2012; 2: 72-83
- 4 ACOG Practice Bulletin No. 222 Gestational Hypertension and Preeclampsia. Obstet Gynecol 2020; 135: e237-e260
- 5 Orabona R, Vizzardi E, Sciatti E. et al. Insights into cardiac alterations after pre-eclampsia: an echocardiographic study. Ultrasound Obstet Gynecol 2017; 49: 124-q33
- 6 Mosca L, Benjamin EJ, Berra K. et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. Circulation 2011; 123: 1243-1262
- 7 Fraser A, Nelson SM, Macdonald-Wallis C. et al. Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children. Circulation 2012; 125: 1367-1380
- 8 Murphy MSQ, Seaborn GEJ, Redfearn DP. et al. Reduced heart rate variability and altered cardiac conduction after pre-eclampsia. PLoS One 2015; 10: e0138664 DOI: 10.1371/journal.pone.0138664.
- 9 Tranquilli AL, Dekker G, Magee L. et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP. Pregnancy Hypertens 2014; 4: 97-104
- 10 Lane-Cordova AD, Khan SS, Grobman WA. et al. Long-term cardiovascular risks associated with adverse pregnancy outcomes: JACC review topic of the week. J Am Coll Cardiol 2019; 73: 2106-2116
- 11 Ahmed R, Dunford J, Mehran R. et al. Pre-eclampsia and future cardiovascular risk among women: A review. J Am Coll Cardiol 2014; 63: 1815-1822
- 12 Rath W, Schlembach D. [Prediction of pre-eclampsia: claim, reality and clinical consequences]. Z Geburtshilfe Neonatol 2013; 217: 117-118
- 13 Castleman JS, Ganapathy R, Taki F. et al. Echocardiographic structure and function in hypertensive disorders of pregnancy: a systematic review. Circ Cardiovasc Imaging 2016; 9: e004888
- 14 Hypertension in pregnancy Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122: 1122-1131
- 15 Croke L. Gestational Hypertension and Preeclampsia: A Practice Bulletin from ACOG. Am Fam Physician 2019; 100: 649-650
- 16 Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000; 183: S1-S22
- 17 Simmons LA, Gillin AG, Jeremy RW. Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy. Am J Physiol Heart Circ Physiol 2002; 283: H1627-H1633
- 18 Oshunbade AA, Hamid A, Lirette ST. et al. Hypertensive diseases in pregnancy, cardiac structure and function later in life: insights from the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Pregnancy Hypertens 2020; 21: 184-190
- 19 Kalafat E, Thilaganathan B. Cardiovascular origins of preeclampsia. Curr Opin Obstet Gynecol 2017; 29: 383-389
- 20 Ghossein-Doha C, Hooijschuur MCE, Spaanderman MEA. Pre-eclampsia: a twilight zone between health and cardiovascular disease?. J Am Coll Cardiol 2018; 03: 12-16
- 21 Melchiorre K, Thilaganathan B, Giorgione V. et al. Hypertensive disorders of pregnancy and future cardiovascular health. Front Cardiovasc Med 2020; 7: 59 DOI: 10.3389/fcvm.2020.00059.
- 22 Ando T, Kaur R, Holmes AA. et al. Physiological adaptation of the left ventricle during the second and third trimesters of a healthy pregnancy: a speckle tracking echocardiography study. Am J Cardiovasc Dis 2015; 5: 119-126
- 23 Melchiorre K, Sharma R, Khalil A. et al. Maternal cardiovascular function in normal pregnancy: evidence of maladaptation to chronic volume overload. Hypertension 2016; 67: 754-762
- 24 Timokhina E, Kuzmina T, Strizhakov A. et al. Maternal cardiac function after normal delivery, preeclampsia, and eclampsia: a prospective study. J Pregnancy 2019; 9795765
- 25 Reyes LM, Usselman CW, Davenport MH. et al. Sympathetic Nervous System Regulation in Human Normotensive and Hypertensive Pregnancies. Hypertension 2018; 71: 793-803
- 26 Greenwood JP, Stoker JB, Walker JJ. et al. Sympathetic nerve discharge in normal pregnancy and pregnancy-induced hypertension. J Hypertens 1998; 16: 617-624
- 27 Greenwood JP, Scott EM, Walker JJ. et al. The magnitude of sympathetic hyperactivity in pregnancy-induced hypertension and preeclampsia. Am J Hypertens 2003; 16: 194-199
- 28 Sumalatha B, Jyotsna M, Indrani G. Electrocardiographic changes during normal pregnancy. Ind J Car Dis Wom 2017; 02: 035-038
- 29 Madras V, Challa N. Electrocardiographic variations during three trimesters of normal pregnancy. Int J Res Med Sci 2015; 2218-2222
- 30 Nandini BN, Shiva Kumar DG, Manjunath ML. et al. Shortening of PR-interval in different trimesters of pregnancy- a cross-sectional study. Int J Biomed & and Adv Res 2011; 2 DOI: 10.7439/ijbar.v2i11.181.
- 31 Angeli F, Angeli E, Reboldi G. et al. Hypertensive disorders during pregnancy: clinical applicability of risk prediction models. J Hypertens 2011; 29: 2320-2323
- 32 Angeli E, Verdecchia P, Narducci P. et al. Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy. Hyperten Res 2011; 34: 707-713
- 33 Isezuo SA, Ekele BA. Eclampsia and abnormal QTc. West Afr J Med 2004; 23: 123-127
- 34 Baumert M, Seeck A, Faber R. et al. Longitudinal changes in QT interval variability and rate adaptation in pregnancies with normal and abnormal uterine perfusion. Hypertens Res 2010; 33: 555-560
- 35 Raffaelli R, Prioli MA, Parissone F. et al. Pre-eclampsia: evidence of altered ventricular repolarization by standard ECG parameters and QT dispersion. Hypertens Res 2014; 37: 984-988
- 36 Khaw A, Kametas NA, Turan OM. et al. Maternal cardiac function and uterine artery Doppler at 11–14 weeks in the prediction of pre-eclampsia in nulliparous women. BJOG 2008; 115: 369-376
- 37 Visser W, Wallenburg HC. Central hemodynamic observations in untreated preeclamptic patients. Hypertension 1991; 17: 1072-1077
- 38 Vaught AJ, Kovell LC, Szymanski LM. et al. Acute cardiac effects of severe pre-eclampsia. J Am Coll Cardiol 2018; 72: 1-11
- 39 Shahul S, Rhee J, Hacker MR. et al. Subclinical left ventricular dysfunction in preeclamptic women with preserved left ventricular ejection fraction: a 2D speckle-tracking imaging study. Circ Cardiovasc Imaging 2012; 5: 734-739
- 40 Shivananjiah C, Nayak A, Swarup A. Echo changes in hypertensive disorder of pregnancy. J Cardiovasc Echogr 2016; 26: 94-96
- 41 Vatten LJ, Skjaerven R. Is pre-eclampsia more than one disease?. BJOG 2004; 111: 298-302
- 42 Buddeberg BS, Sharma R, O’Driscoll JM. et al. Cardiac maladaptation in term pregnancies with preeclampsia. Pregnancy Hypertens 2018; 13: 198-203