65 Changes of maternal cardiac function in patients with mild and severe preeclampsia

Abstract

Introduction Preeclampsia is one of the major causes of maternal and perinatal mortality and morbidities. Pregnancy is characterized by certain structural and functional changes in the cardiovascular systems. However, to date, few studies were conducted about the influence in severity of preeclampsia to maternal cardiac function and the structural changes. Objectives We examined maternal cardiac function in patients with preeclampsia during peripartum period and compared with normal pregnant women. Methods A total of 138 singleton patients with preeclampsia and 18 singleton pregnant women without preeclampsia were enrolled in this study. We defined severe preeclampsia as systolic blood pressure over 160 mmHg or diastolic blood pressure over 110 mmHg. Echocardiography was conducted three times during peripartum period; late stage of pregnancy, early postpartum and one-month postpartum. We did not perform echocardiography at one-month postpartum to the non-preeclamptic women. We measured intraventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (EF), left atrium diameter (LAD) and early transmitral velocity/early diastolic velocity of the mitral annulus (E/e′). Statistical analysis of covariance with age were performed with the SPSS software package. Results There were 87 patients who had severe preeclampsia, 51 patients with mild preeclampsia and 18 normal pregnant women. In these groups, there were no differences in pre-pregnancy BMI. In late stage of pregnancy, whereas only IVST was significantly dilated between the normal pregnant and mild preeclampsia, some parameters were significantly decayed in the patients with severe preeclampsia. All parameters excluded LVIDs and EF were dilated between the normal and severe preeclampsia. IVST, LVIDd and LAD were significantly different between the mild and severe preeclampsia. In early postpartum, there were no differences between the normal and mild preeclampsia. LVIDs was significantly dilated in severe preeclampsia compared with normal pregnant women. LVIDd, LVIDs and LAD were significantly different in the mild and severe preeclampsia. In one-month postpartum, LVIDd and LVIDs were significantly different between the preeclampsia patients. Concerned about EF, there was no significantly difference in three groups through these periods. The table shows these detailed results. Conclusion Mild preeclampsia had influences on maternal cardiac functions and, after delivery, the changes recovered within a few days. However, severe preeclampsia patients got cardiac remodeling and these changes did not recover completely even one-month postpartum. Not only anatomical changes but also left ventricular diastolic function deteriorated in severe preeclampsia compared with mild preeclampsia patients and normal pregnant women. Therefore, the severity of preeclampsia should be considered when examining maternal cardiac function and the risk of future cardiovascular disease in patients with preeclampsia. Download : Download high-res image (265KB) Download : Download full-size image