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Maternal Cardiac Function at Midgestation and Development of Preeclampsia

Research output: Contribution to journalArticlepeer-review

Elena Gibbone, Iulia Huluta, Alan Wright, Kypros H. Nicolaides, Marietta Charakida

Original languageEnglish
Pages (from-to)52-62
Number of pages11
JournalJournal of the American College of Cardiology
Volume79
Issue number1
DOIs
Published4 Jan 2022

Bibliographical note

Funding Information: This study was supported by a grant from the Fetal Medicine Foundation (charity no: 1037116). The ultrasonography machines for maternal echocardiography and the software for speckle tracking analysis were provided free of charge by Canon Medical Systems Europe BV, Zoetermeer, the Netherlands. The reagents and equipment for the measurement of serum placental growth factor and soluble fms-like tyrosine kinase-1 were provided by Thermo Fisher Scientific. These bodies had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2022 American College of Cardiology Foundation

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Abstract

Background: Preeclampsia (PE) is an independent risk factor for adverse maternal cardiovascular outcomes. The role of maternal cardiac function in the pathophysiology of PE remains unclear. Objectives: This study sought to describe differences in cardiac function at midgestation between women who develop PE and those with uncomplicated pregnancy and to establish whether routine cardiac assessment at midgestation can improve performance of screening for PE achieved by established biomarkers. Methods: Mean arterial pressure was measured, medical history was obtained, and left ventricular (LV) systolic and diastolic functions were assessed using standard echocardiography and speckle tracking imaging. Uterine artery pulsatility index and serum placental growth factor and soluble fms-like tyrosine kinase-1 were measured. Results: In 4,795 pregnancies, 126 (2.6%) developed PE. Following multivariable analysis, peripheral vascular resistance was significantly higher and LV global longitudinal systolic strain, ejection fraction, cardiac output, and left atrial area were mildly lower in women who developed PE compared to those who did not. There was a weak association between maternal cardiovascular indices and biomarkers of placental perfusion and function. Cardiac indices did not improve the performance of screening for PE on top of maternal risk factors, mean arterial pressure, and biomarkers of placental perfusion and function. Conclusion: Women who develop PE have an increase in peripheral vascular resistance and a mild reduction in LV functional cardiac indices long before PE development. However, cardiac indices do not improve the performance of screening for PE; thus, their routine clinical use is not advocated.

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