339: Effectiveness of low-dose aspirin versus calcium supplementation for the prevention of pre-eclampsia: a systematic review with an indirect comparison meta-analysis of randomized trials

Abstract

338 Pulmonary edema (PE) is associated with left ventricular diastolic dysfunction (DD) in preeclampsia with severe features (PEC-SF) Arthur J. Vaught, Sara M. Seifert, Sammy Zakaria, Monica Mukherjee, Dhanajay Vaidya, Jason M. Rosenzweig, Susan Mayer, Sarah York, Cynthia H. Argani, Jamie Murphy, Linda M. Szymanski The Johns Hopkins School of Medicine, Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Baltimore, MD, The Johns Hopkins School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD, The Johns Hopkins School of Medicine, Department of Medicine, Division of Cardiology, Baltimore, MD, The Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, The Johns Hopkins School of Medicine, Integrated Research Center for Fetal Medicine, Baltimore, MD, The Johns Hopkins School of Medicine, The Johns Hopkins School of Medicine, Department of Anesthesia Critical Care Medicine, Department of Gynecology and Obstetrics, Division of Obstetrics, Gynecology, and Fetal Anesthesiology, Baltimore, MD OBJECTIVE: PE is a rare complication of preeclampsia affectingw 2% of cases. Main contributors are likely excessive volume overload, leaky capillary syndrome, and hypoventilation from magnesium administration. Echocardiography (ECHO) uses mitral inflow (E) velocity and mitral annular (e’) velocity to assess left-sided filling pressures and diastolic function by septal E/e’ ratio. Ratios > 15 are associated with increased filling pressures and DD. We sought to assess the association of DD and PE in women with PEC-SF using the E/e’ ratio. STUDY DESIGN: Participants were recruited from the Johns Hopkins Health System. Inclusion criteria: singleton pregnancies > 23 weeks and diagnosis of PEC-SF as defined by ACOG (Hypertension in Pregnancy, 2013). Exclusion criteria: multiple gestation, known valvular malformations, previous cardiac surgery, known pulmonary hypertension, history of pulmonary embolism, or interstitial lung disease. Participants were subdivided into PEC-SF with and without PE. ECHO was performed at time of diagnosis of PEC-SF, and prior to pulmonary symptoms. PE was confirmed with radiographic imaging. Statistical analyses were performed using Chi square, t-tests, Fisher’s exact, and Mann-Whitney U tests (STATA Version 13). RESULTS: 56 women with PEC-SF participated; 5/56 (8.9%) were diagnosed with PE. Descriptive data were similar between groups (Table 1). Mean septal E/e’ in PEC-SF groups was above the normal range (Table 2). PEC-SF with PE had higher septal E/e’ than PEC-SF without PE. 4/5 with PE required diuretic therapy. All other ECHO parameters were similar between groups. CONCLUSION: There was a statistically significant difference in septal E/e’ in preeclamptic women with and without PE. These findings suggest a possible component of DD in PEC-SF, especially if PE develops. Furthermore, ECHO was performed before symptoms and diagnosis of PE raising the possibility of this being a screening tool for at risk populations.