Echocardiography In Women Research Articles

Mental Stress-Induced Myocardial Ischemia Detected by Global Longitudinal Strain and Quantitative Myocardial Contrast Echocardiography in Women With Nonobstructive Coronary Artery Disease

The utility of radionuclide myocardial perfusion imaging including positron emission tomography (PET) for diagnosing mental stress-induced myocardial ischemia (MSIMI) is clinically restricted. This study aims to assess the diagnostic performance of novel echocardiographic techniques, including automated strain and quantitative myocardial contrast echocardiography (MCE) with dedicated software and deep neural network model, for MSIMI detection. The secondary objective was to explore the correlation between changes in myocardial blood flow and MSIMI. Seventy-two female patients ages 18 to 75 with angina and nonobstructive coronary artery disease (ANOCA) and 23 healthy controls were prospectively recruited. Both echocardiography with contrast agent and PET imaging were performed during structured mental stress testing. Mental stress-induced myocardial ischemia was defined as a summed difference score ≥3 on PET. Echocardiographic parameters including left ventricular global longitudinal strain, β, and A×β were obtained, and their trends during mental stress testing were observed. ΔGLS was defined as the ratio of difference between global longitudinal strain values at stress and rest to the rest data. β reserve and A×β reserve were respectively calculated. Thirty-two ANOCA patients (44%) and 1 control (4%) were diagnosed with MSIMI (P<.01). For ANOCA patients with MSIMI, left ventricular GLS, β, and A×β declined to varied extents during mental stress testing compared with those without MSIMI and the controls (P<.05). Bland-Altman plots demonstrated good consistency between β reserve and A×β reserve output by the deep neural network model and iMCE software. Receiver operating characteristic curve analyses showed that ΔGLS, β reserve, and A×β reserve demonstrated favorable ability to predict MSIMI, especially the combination of A×β reserve using iMCE analysis and ΔGLS (area under the curve, 0.94; sensitivity, 83%; specificity, 97%). Novel technologies in echocardiography exhibit the potential to be a clinical alternative to cardiac PET for effectively detecting MSIMI. Attenuated myocardial blood flow response during structured mental stress testing was correlated with MSIMI, providing a reasonable explanation for the chest discomfort persisting in ANOCA women.

Comparative effectiveness of exercise electrocardiography versus exercise echocardiography in women presenting with suspected coronary artery disease: a randomized study.

There is a paucity of randomized diagnostic studies in women with suspected coronary artery disease (CAD). This study sought to assess the relative value of exercise stress echocardiography (ESE) compared with exercise electrocardiography (Ex-ECG) in women with CAD. Accordingly, 416 women with no prior CAD and intermediate probability of CAD (mean pre-test probability 41%), were randomized to undergo either Ex-ECG or ESE. The primary endpoints were the positive predictive value (PPV) for the detection of significant CAD and downstream resource utilization. The PPV of ESE and Ex-ECG were 33% and 30% (P = 0.87), respectively for the detection of CAD. There were similar clinic visits (36 vs. 29, P = 0.44) and emergency visits with chest pain (28 vs. 25, P = 0.55) in the Ex-ECG and ESE arms, respectively. At 2.9 years, cardiac events were 6 Ex-ECG vs. 3 ESE, P = 0.31. Although initial diagnosis costs were higher for ESE, more women underwent further CAD testing in the Ex-ECG arm compared to the ESE arm (37 vs. 17, P = 0.003). Overall, there was higher downstream resource utilization (hospital attendances and investigations) in the Ex-ECG arm (P = 0.002). Using National Health Service tariffs 2020/21 (British pounds) the cumulative diagnostic costs were 7.4% lower for Ex-ECG compared with ESE, but this finding is sensitive to the cost differential between ESE and Ex-ECG. In intermediate-risk women who are able to exercise, Ex-ECG had similar efficacy to an ESE strategy, with higher resource utilization whilst providing cost savings.

Strain analysis by two-dimensional speckle tracking echocardiography for evaluating left ventricular systolic function in women with pre-eclampsia

Abstract Background Previous echocardiographic studies have shown that most women affected by pre-eclampsia present with mild-to moderate diastolic dysfunction and left ventricle remodelling with a preserved systolic function. These alterations appear more severe when pre-eclampsia develops before 34 weeks of gestation. Purpose The aim of this study is to compare left ventricular systolic (LV) function by using 2-D speckle tracking echocardiography in women with early-onset and late-onset pre-eclampsia. Methods In this single-centre prospective longitudinal study, 119 women with a diagnosis of pre-eclampsia underwent standard trans-thoracic echocardiography (TTE) in the immediate peripartum period from February 2019 to December 2020. LV function was assessed using two-dimensional speckle-tracking strain imaging on 4-chamber views with a frame rate of 60–90 frames/second. Strain analysis quantification was performed using a commercial software. Results Pre-eclampsia was diagnosed before and after 34 weeks in 37.3% (44/119) and 62.7% (74/119) of the patients, respectively. Maternal characteristics, such as maternal age, body mass index, pre-existing hypertension and nulliparity, did not show any significant difference between the two groups. Although LV remodelling/hypertrophy and diastolic dysfunction occurred more often in early-onset pre-eclampsia compared to late-onset (65.9% vs 60.8% and 59.1% vs 51.4%, respectively), this difference was not statistically significant (p=0.580 and p=0.414, respectively). Similarly, LV mass index was 80.1±16.3 in pre-eclampsia &amp;lt;34 and 79.1±15 &amp;gt;34 (p=0.715) and E/e' was 7.8±1.9 and 7.6±1.7 (p=0.424). However, global longitudinal strain (GLS) was significantly lower (−16.4±2.4 vs −17.6±2.4, p=0.030) and apical rotation was higher (11.1±5.9 vs 8.7±4.7, p=0.019) in early-onset pre-eclampsia. A positive weak correlation has been found between GLS and difference in days from pre-eclampsia diagnosis to delivery (r=0.2, p=0.002). Conclusions Lower GLS in women affected by early-onset pre-eclampsia compared to late-onset pre-eclampsia might be useful to detect sub-clinical LV systolic impairment. Although further studies are needed, this sensitive marker may have a role in identifying women at risk of preterm delivery and/or severe maternal morbidity in the peripartum period. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Veronica Giorgione and Carolina Di Fabrizio have received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 765274 (iPLACENTA project).

Assessing the Stress Echocardiography in Women With Breast Arterial Calcification.

Objective: breast arterial calcification (BAC) is one of the most prevalent mammographic findings and has been debated as a marker of cardiovascular disease (CVDs). The present study aimed to assess the findings of stress echo in women with BAC. Materials and methods: This cross-sectional study was conducted on women who undergo mammography for routine breast cancer screening at Imam Reza hospital, western Iran from March 2018 to July 2018. The patients underwent stress echocardiography to evaluate the probability of myocardial ischemia (MI). Chi-square and independent t-tests were used to assess the differences between subgroups. Results: BAC was present in 61 (15.2%) women. The mean age of the patients with BAC was significantly higher than the patients without BAC (58.59± 7.82 vs. 55.32±6.57, p =0.003). Prevalence rates of the menopause (88.5% vs. 71.1%, p=0.009), hypertension (29.5% vs. 17.7%, p=0.032), and hypercholesterolemia (24.6% vs. 13.0, p=0.018) were significantly higher in the patients with BAC compared to the patients without BAC. The prevalence rate of MI symptoms in the patients with BAC was equal to 24.6%. Significantly, more women with BAC were positive for myocardial ischemia compared to the women without BAC (24.6% vs. 8.5%, p<0.001). The prevalence rates of the diabetes mellitus, hypertension, hypercholesterolemia, and history of CVDs were significantly higher in the patients who were positive for MI. Conclusion: It was found that BACs are correlated with an increased occurrence rate of CVDs. Our results illustrated that the patients who were positive for MI were more plausible to be diabetic, hyperlipidemic, hypertensive, and having a history of CVDs.

Echocardiography in Women: How Are Mars and Venus Different?

Sex is an important determinant of cardiac structure and function. We review key sex differences in universal echocardiographic parameters and discuss the clinical implications of using sex-specific algorithms to increase the diagnostic accuracy of echocardiography and improve the timely treatment of common cardiovascular disorders, and the unique role of echocardiography in pregnancy and the evaluation of ischemic heart disease. Emerging echocardiographic findings have begun to define important sex-based differences in chamber size and ventricular function. We advocate for additional research and the consideration of sex-specific algorithms in future expert consensus guidelines for the diagnosis and treatment of valvular heart disease, heart failure, and thoracic aortic disease. Echocardiography is an essential diagnostic tool in our armamentarium of imaging modalities for the sex-specific diagnosis and guidance of treatment for a broad spectrum of cardiovascular disorders.

Early Use of Handgrip Exercise Associated with Dobutamine Stress Echocardiography in Women

Background Coronary artery disease (CAD) is an important cause of morbidity and mortality in women and requires early diagnosis for defining the appropriate treatment. Objective To identify the positive predictive value (PPV) and safety of the early use of handgrip exercise in pharmacological stress echocardiography using dobutamine (early-ECHO) in women. Methods Positive ischemic early-ECHO records from 111 women were evaluated from January 2012 to March 2018. Subsequently, the hospital medical records were verified to locate patients who underwent conventional [...]

Noninvasive Assessment of Right Ventricle Function and Pulmonary Artery Pressure Using Transthoracic Echocardiography in Women With Pre-Eclampsia: An Exploratory Study.

Background and objectivePre-eclampsia (PEC) is associated with the release of anti-angiogenic factors that are incriminated in raising systemic and pulmonary vascular resistance (PVR). Compared to the left heart and systemic circulation, much less attention has been paid to the right heart and pulmonary circulation in patients with PEC. We used transthoracic echocardiography (TTE) to estimate pulmonary artery (PA) pressure and right ventricular (RV) function in women with PEC.Materials and methodsWe conducted a case-control study at a tertiary care academic center. Ten early PEC (<34-week gestation) and nine late PEC (≥34-week gestation) patients with 11 early and 10 late gestational age-matched controls were enrolled. Two-dimensional TTE was performed on all patients. The estimated mean PA pressure (eMPAP) was calculated based on PA acceleration time (PAAT). PVR was estimated from eMPAP and RV cardiac output (RV CO). RV myocardial performance index (RV MPI), tricuspid annular plane systolic excursion (TAPSE), tissue tricuspid annular displacement (TTAD), and lateral tricuspid annular tissue peak systolic velocity (S’) were measured.ResultsCompared to early controls, in early PEC, the eMPAP and estimated PVR (ePVR) were elevated, PAAT was reduced, RV MPI was increased, TTAD was reduced, and TAPSE and TV S’ were unchanged. Compared to late controls, in late PEC, the eMPAP and ePVR were elevated, PAAT was reduced, and RV MPI was increased, while TAPSE, TTAD, and TV S’ were unchanged.ConclusionsIn a sample of women with PEC, early PEC was found to be associated with increased eMPAP and ePVR and subclinical decrement of RV function as assessed by TTE. TTE may be a useful noninvasive screening tool for early detection of pulmonary hypertension and RV dysfunction in PEC. An adequately powered longitudinal study is needed to determine the implications of these findings on long-term outcomes.

Can we predict and take a proper treatment for postpartum pulmonary embolism? A single institution review of five cases

Postpartum pulmonary embolism (PPE) is a rare disorder in the puerperium that can present a wide range of symptoms after childbirth. This condition can lead to death and is the most common cause of maternal mortality, accounting for about 10% of all maternal deaths in the United States. A previous study conducted over 3 years (2014-2016) followed five patients diagnosed with postpartum pulmonary embolism, two of whom died. As PPE is characterized by a variety of symptoms, patients suspected of this condition require prompt diagnosis and treatment. Based on the previous investigation of five patients, the present study aimed to elucidate considerations for early treatment and diagnosis. Maternal mortality can be minimized by proper treatment and early detection using contrast-enhanced chest computerized tomography and echocardiography in women during or after delivery, particularly those with suspected embolism.

1676 Prediction of different causes of mortality by exercise echocardiography in women

Abstract Exercise echocardiography (ExE) can predict overall and cardiovascular mortality. We aimed to assess the value of ExE for the prediction of cardiovascular (CV), cancer (CA) and non-cardiovascular non-cancer (NCV-NCA) death in women. Methods Retrospective analysis of prospectively collected data on 4,714 women (age 64 ± 11 years) with a first treadmill ExE performed in our center for known/suspected coronary artery disease. Exclusion criteria were significant valve disease, cardiomyopathy, congenital heart disease, and age &amp;lt;18 year-old. Ischemia was defined as the development of new wall motion abnormalities (WMAs) with exercise; abnormal ExE as ischemia or resting WMAs. A good functional capacity was defined as a maximal workload of 10 metabolic equivalents (METs). The end point was death (CV, CA or NCV-NCA). Results During a follow-up of 4.6± 4.7 years (interquartile range 0.04-8.0 years) there were 345 CV, 164 CA, and 203 NCV-NCA deaths. Multivariate analysis included clinical characteristics, resting echocardiography, exercise testing and peak exercise echocardiography. Different clinical characteristics predicted CV death, along with maximal achieved workload in Metabolic Equivalents (METs: Hazard Ratio [HR] = 0.92, 95% Confidence Interval [CI] = 0.88-0.96, p &amp;lt; 0.001) and ExE variables. CA death was independently predicted by age and achieved METs (HR = 0.93, 95% CI =0.87-0.99, p &amp;lt; 0.02). Similarly NCV-NCA death was predicted by clinical characteristics (age, diabetes mellitus, diuretics, nitrites) and also by achieved METs (HR = 0.83, 95% CI= 0.78-0.88, p &amp;lt; 0.001). Nor ischemia nor abnormal ExE increased the risk for CA or NCV-NCA death. Annualized CV deaths were almost quadruple in women with bad functional capacity as compared to those with good functional capacity (2.2% vs. 0.6%, p &amp;lt; 0.001). The same occurred for NCV-NCA death (1.4% vs. 0.3%, p &amp;lt; 0.001), whereas CA deaths were double in patients with bad functional capacity (0.9% vs. 0.4%, p &amp;lt; 0.001). In conclusion, an ExE study can predict not only CV death, but death due to CA or to NCV-NCA. Fit women based on the achievement of 10 METs during exercise testing, have less chance of death from any cause.

Layer-specific longitudinal strain analysis by speckle tracking echocardiography in women with early and late onset preeclampsia.

Layer-specific longitudinal strain analysis by speckle tracking echocardiography in women with early and late onset preeclampsia.

Usefulness of Screening for Abdominal Aortic Aneurysm During Transthoracic Echocardiography in Women ≥50 Years of Age

Usefulness of screening for abdominal aortic aneurysm (AAA) during transthoracic echocardiography (TTE) in women is uncertain. The aim of the present study was to clarify the clinical usefulness of screening for AAA during TTE and to identify important TTE indices associated with AAA in women in a routine clinical setting. We prospectively studied 1,495 women (≥50 years) referred for TTE. AAA was defined as ≥30 mm in size. The additional screening time for AAA was <1 minute. The abdominal aorta was visualized in 95.1 % (1,422 of 1,495) using the same TTE probe. AAA was identified in 1.9% (27 of 1422). The aortic root size was larger in patients with AAA than those without (33.3 ± 3.2 vs 30.5 ± 3.4 mm, p < 0.001). The aortic root size had a correlation with abdominal aortic size (r = 0.22, p < 0.001). The aortic root size of ≥30.3 mm was predictive of AAA (area under the curve = 0.74, p < 0.001) and all patients with AAA had the aortic root size of ≥28.0 mm. Multiple logistic regression analysis revealed that the aortic root size (Odds ratio 1.17, p = 0.007) was a most independent TTE index of AAA. In conclusion, the visibility of the abdominal aorta using TTE probe was excellent. When the aortic root size is ≥28.0 mm during TTE in women ≥50 years of age, screening for AAA should be carried out.

STRUCTURAL AND FUNCTIONAL CHANGES OF MYOCARDIUM IN WOMEN WITH OSTEOPOROSIS IN COMBINATION WITH ISCHEMIC HEART DISEASE

The aim of our study was to determine the characteristics of structural and functional changes of myocardium and aorta by echocardiography in women with ischemic heart disease (IHD) cause-specific from the presence of osteoporosis. Materials and methods. We examined 170 postmenopausal women aged from 57 to 78. Inclusion criteria: female gender, age over 50 years, the presence of menopause, the presence of IHD. Exclusion criteria: endocrine system diseases, severe heart failure, respiratory insufficiency, secondary osteoporosis. Postmenopausal osteoporosis was diagnosed according to the Clinical Recommendations for the Prevention and Management of Osteoporosis Patients (2016). All women were divided into 2 groups: group 1 – 72 women with proven diagnosis of osteoporosis and IHD, group 2 – 98 patients with isolated IHD (comparison group). IHD was represented by 2 forms: angina pectoris and postinfarction cardiosclerosis. The frequency of postinfarction cardiosclerosis was not statistically different between groups. Also the groups were comparable in age, weight, body-weight index, levels of peripheral (office) blood pressure. Results. In women with osteoporosis and IHD we revealed higher values of interventricular septum thickness (p = 0.034), left ventricle posterior wall (p = 0.004), and the relative thickness of left ventricular posterior wall (p = 0.0038). An increasing rate of left ventricular hypertrophy was observed in patients with combination of osteoporosis and IHD – 51.4 % versus 39.8 % in women with IHD without osteoporosis (p = 0.002). Osteoporosis was associated with a higher incidence of diastolic left ventricular dysfunction: 90 % versus 70.4 %, as well as with pathological types of left ventricular remodeling (p = 0.01); concentric remodeling type dominated among women with combined pathology (p = 0.09). A higher incidence of aorta calcification 1.86 times (p = 0.00013) and calcified aortic stenosis (13.8 % versus 4.08 %; p = 0.02) were noted in patients with osteoporosis. Conclusion. We found that osteoporosis in postmenopausal women was associated with an increasing of heart remodeling parameters, an increasing of diastolic dysfunction frequency and pathological types of left ventricle geometric remodeling with prevalence of concentric type remodeling. Patients with osteoporosis had a higher prevalence of aortic calcification and calcified aortic stenosis.

The efficacy of peripartum transthoracic echocardiography in women with preeclampsia.

To examine the features and efficacy of transthoracic echocardiography (TTE) in preeclampsia. We retrospectively reviewed the medical records of 145 pregnant women with preeclampsia, who underwent TTE at Seoul St. Mary's Hospital between July 2006 and June 2016. We analyzed echocardiographic features in preeclampsia and the relationship between the severity of preeclampsia and TTE findings. Additionally, we examined the predictive echocardiographic factors of persistent hypertension and calculated the adjusted odds ratio (OR) and 95% confidence interval (CI) for multiple regression models by considering systolic and diastolic blood pressure and pre-pregnancy body mass index (BMI). Hemodynamic findings assessed by TTE in women with preeclampsia included systolic and diastolic dysfunction, increased left ventricular mass, and enlarged left atrium. Diastolic dysfunction and left ventricular hypertrophy (LVH) were more common in preeclampsia with severe features (39.84% vs. 32.05%, p=0.010, and 21.79% vs. 8.96%, p=0.041, respectively). In the patients with systolic dysfunction, the adjusted OR for persistent hypertension was 17.41 (95% CI=2.83-107.20). The ORs for grade 1 and grade 2 diastolic dysfunction were 12.58 and 32.84, respectively (95% CI, 2.99-52.92 and 3.61-298.58, respectively). When LVH assessed by TTE was considered with diastolic dysfunction, the risk for persistent hypertension increased (OR 19.28; 95% CI-4.36-85.20). TTE not only can reveal the severity of preeclampsia, but also can be a useful tool for the follow-up of persistent hypertension.

38 Cardiac structure and function six months after normal and hypertensive pregnancies – The P4 study

Introduction Hypertensive disorders of pregnancy (HDP) are associated with increased post-partum cardiovascular risk in comparison to normal pregnancy (NP). Changes in cardiac structure and function following an HDP have been described previously but whether such changes are useful in identifying women at increased cardiovascular risk is not known. Echocardiography is a non-invasive tool used in the detection of early systolic and diastolic dysfunction. Objectives To assess cardiac structure and function by echocardiography in women, 6months after NP or pregnancy complicated by either gestational HT or pre-eclampsia (HDP group). Methods The study enrolled a prospective cohort of women recruited to the ongoing P4 (Postpartum Physiology, Psychology, and Paediatric follow up) study at St George Hospital, Kogarah, Sydney. Echocardiography was performed six months after either NP or HDP. Trained cardiac sonographers were blinded to whether women had a NP or an HDP. All studies were performed on the Phillips iE33 and Epic machines at St George Hospital. Women with known chronic hypertension were excluded. Statistical analysis was completed using independent t -tests. Results Forty eight women have been recruited to date ( n =22 NP, n =26 HDP). The HDP group showed subtle evidence of structural change with trend to increased 2D ventricular septal wall thickness (8.9±1.3 v 3±0.9mm, HDP v NP, p =0.08), increased posterior wall thickness (8.8±1.1 v 7.8±0.7mm, HDP v NP, p p p 1.0). Systolic function was similar between groups, measured by ejection fraction (63±4 v 62±15, HDP v NP, p =n.s.) and global longitudinal strain (−19.3±1.6 v −19.8±5.3, HDP v NP, p =n.s.). All of the echocardiographic parameters reported above were within normal ranges. Conclusions Six months post-partum, women with prior HDP had early structural and functional changes compared to NP. There were no features of systolic dysfunction or strain but there were subtle features of increased ventricular mass and diastolic dysfunction. In another abstract, we have reported that the same HDP group have higher 24h brachial and central BP. The cardiac changes are within (current) normal ranges and unlikely to be useful alone in predicting increased CV risk, but may be useful in future if included in CV risk algorithms.

Peripheral Reactive Hyperemia Index and Coronary Microvascular Function in Women With no Obstructive CAD: The iPOWER Study

ObjectivesThis study investigated whether digital reactive hyperemia index (RHI) measured by digital pulse amplitude tonometry is a sensitive indicator of coronary microvascular dysfunction (CMD). BackgroundCMD is an early marker of cardiovascular disease. However, CMD is a complex diagnosis and consists of multiple abnormalities of the coronary circulation. Impaired RHI is a noninvasive measure of peripheral vascular dysfunction that can identify individuals with acetylcholine induced coronary vascular dysfunction. It is largely unknown whether there is also an association between RHI and the endothelial-independent aspect of CMD assessed as a coronary flow velocity reserve (CFVR). MethodsWe included 339 women with chest pain suggestive of angina pectoris and a diagnostic invasive coronary angiogram without significant coronary artery stenosis (<50%). CFVR was measured by transthoracic pulsed wave Doppler echocardiography during dipyridamole infusion (0.84 mg/kg). RHI was assessed by digital pulse amplitude tonometry. Participants were categorized in 3 RHI and 3 CFVR groups. We examined the association between CFVR and RHI and the distribution of cardiovascular risk factors between the CFVR and RHI groups. ResultsCFVR and RHI were successfully measured in 322 participants. Median CFVR was 2.3 (interquartile range: 2.0 to 2.8) and median RHI was 2.1 (interquartile range: 1.6 to 2.6). No correlation was found between CFVR and RHI (Spearman’s rho = –0.067, p = 0.23), and mean RHI did not differ between CFVR categories (p = 0.39). Participants with low CFVR were significantly older and had a significantly greater burden of hypertension, whereas participants with an impaired RHI had a higher body mass index and were more likely to have diabetes and be current smokers. ConclusionsRHI does not identify individuals with CMD assessed as impaired CFVR by dipyridamole stress echocardiography in women with no obstructive coronary artery disease. The two methods are likely to identify different aspects of vascular pathology, as indicated by the different association with cardiovascular risk factors.

Maternal Cardiac Diastolic Dysfunction by Doppler Echocardiography in Women with Preeclampsia.

Preeclampsia may lead to heart failure in late pregnancy and early puerperium. Diastolic dysfunction may be the cause of heart failure in these patients. There is paucity of data on diastolic dysfunction in patients with preeclampsia. To assess cardiac diastolic dysfunction in women with preeclampsia by Doppler echocardiography and to correlate severity of dysfunction with severity of preeclampsia. One hundred and fifty nulliparous women in age group of 20-35 years were recruited for the study. Among these, 120 women with preeclampsia were taken as cases and 30 normotensive women as controls. Doppler echocardiography was carried out between 28-36 weeks of gestation in both groups to assess and grade severity of diastolic dysfunction. Of 120 women with preeclampsia, 61 had mild preeclampsia and 59 had severe preeclampsia. Diastolic dysfunction was seen in 25(20.8%) cases. Among these, grade I diastolic dysfunction was seen in 40% and the rest 60% had grade II diastolic dysfunction. In the mild preeclampsia group, only 2(3.3%) patients had diastolic dysfunction. Both had grade I dysfunction. Of severe preeclampsia patients, 8(13.6%) had grade I and 15(25.4%) had grade II diastolic dysfunction (p=0.001). None of these progressed to heart failure or pulmonary oedema. Systolic function assessed by left ventricular ejection fraction was normal in all cases. All controls had normal systolic and diastolic functions. Cardiac diastolic dysfunction occurred in one-fifth of women with preeclampsia. Grade of diastolic dysfunction correlated with the severity of preeclampsia.

Transthoracic echocardiography in women with preeclampsia

Recent literature on the role of transthoracic echocardiography in the management of women with preeclampsia is reviewed with emphasis on recommendations for its use in the life-threatening complications of acute pulmonary edema, chest pain, and hemorrhage. The diagnostic criteria for preeclampsia are closer to reaching international consensus with most guidelines now removing the mandatory requirement for proteinuria. Hemodynamic findings using transthoracic echocardiography in women with untreated preeclampsia include normal or increased cardiac output, normal or increased contractility, a nondilated left ventricle, diastolic dysfunction, increased pericardial effusions, and increased left ventricular mass. Echocardiography is recommended as a diagnostic and monitoring tool for acute hemodynamic complications of preeclampsia, such as acute pulmonary edema, significant arterial hypertension, and chest pain. Despite this there has been limited uptake of transthoracic electrocardiography into routine clinical practice in women with preeclampsia. The role of transthoracic echocardiography in the management of women with preeclampsia is emphasized by international groups. Research into the hemodynamics in preeclampsia, which demonstrates preserved ejection fraction, and diastolic dysfunction highlights its utility and acceptability by pregnant women with preeclampsia. Training of obstetric anesthesiologists in echocardiography is necessary to enable more widespread implementation of this important technology.

Transthoracic Echocardiography in Women With Treated Severe Preeclampsia

Transthoracic Echocardiography in Women With Treated Severe Preeclampsia

30-OR

Objectives Cathepsin D has been implicated in the development of preeclampsia and peripartum cardiomyopathy. We sought to examine the association of cathepsin D with cardiac dysfunction on echocardiography in women with preeclampsia. Methods Preeclamptic women aged 18–43 were recruited for this IRB approved study. Demographics, clinical data, and outcomes were recorded throughout the antepartum and postpartum course. Serum for cathepsin D activity and placental growth factor (PlGF) was drawn at the time of clinical labs. PlGF (pg/ml) was determined using ELISA. Cathepsin D activity (μM) was determined using a fluorimetric Sensolyte® 520 Immunoassay. Bedside transthoracic echocardiography was performed antepartum and postpartum for determination of standard myocardial function parameters as well as myocardial strain with speckle tracking. Statistical analyses included t-test, ANOVA, and pairwise correlations. Results We enrolled 23 women with mild (n = 10) and severe (n = 13) preeclampsia. Echocardiography was available antepartum on 21 women (strain imaging on 8) and postpartum on 17 women (strain imaging on 11). Mean age was 28.7 ± 5.6 years. Most women were Caucasian (n = 21) and primigravida (n = 14). Average gestational age at enrollment was 32.0 ± 4.8 weeks. Increasing ratio of cathepsin D activity to PlGF was associated with worsening longitudinal strain antepartum (p = 0.02). Postpartum, increasing ratio of cathepsin D to PlGF was associated with decreasing fractional shortening (p = 0.02). Conclusions Ratio of cathepsin D activity to PlGF is associated with subclinical cardiac dysfunction as determined by speckle tracking for cardiac strain as well as fractional shortening on echocardiography. A ratio of cathepsin D activity to PlGF as a marker of anti-angiogenic factors to pro-angiogenic balance better indicates this association than cathepsin D activity alone. Disclosures C.F. Pearce: None. G.S. Dhaliwal: None. M. Keihanian: None. S. Mast: None. R.I. Pollack: None. J.M. O’Brien: None. W.F. Hansen: None. T.E. Curry: None. A.L. Bailey: None.

0260: Relation of presence and severity of metabolic syndrome with left atrial mechanics in patients, a deformation imaging study

We aimed to investigate left atrium (LA) function by speckle tracking echocardiography in women with metabolic syndrome (MetSyn) admitted in chest pain unity with normal coronary angiography and to show a possible relationship between the severity of MetSyn and LA function we included 180 MetSyn patients without diabetes and 50 controls. The patients were classified into three groups based on the number of MetSyn criteria. The peak LA strain at the end of the ventricular systole (LAs-strain) as well as the LA strain with LA contraction (LAa-strain) was obtained. Correlation analysis performed to assess the association of LA strain parameters with the severity of MetSyn and logistic regression analysis performed to assess the relationship of low LA strain with MetSynd Both LAs (33.5±6.7 vs. 24.3±11.2, p<0.01) and LAa (20.4±4.2 vs. 13.0±6.4, p<0.001) strain measurements were found to be significantly decreased in patients with MetSyn when compared to the control group. Moreover, both LAs and LAa were found to be significantly decreased with the increasing severity of the MetSyn. A multiple logistic regression analysis demonstrated that the presence of MetSyn [OR:0.34 (95% CI 0.04-0.89), p=0.032] and left ventricular ejection fraction [OR:1.23 (95% CI 1.02-1.77), p=0.03] were independent predictors of LAs strain. MetSyn is associated with reduced LAs strain and LAa strain representing LA reservoir and pump function, respectively. Furthermore, LA mechanical function decreases even more with the increasing severity of the MetSyn.