Maternal cardiac parameters can help in differentiating the clinical profile of preeclampsia and in predicting progression from mild to severe forms.

Abstract

BACKGROUND\nA primary role of maternal heart dysfunction in the pathophysiology of preeclampsia had been previously advocated although if contradictory results have been reported.\n\n\nOBJECTIVES\nto describe maternal hemodynamic parameters according to two main preeclampsia phenotypes and to investigate if cardiac findings may be helpful in characterizing the severity and the progression of the disease STUDY DESIGN: This was a prospective cohort study. We used ultrasonic cardiac output monitor (USCOM 1A Ltd, Ultrasound Cardiac Output Monitor, Sydney, N.S.W., Australia) system to compare the hemodynamic parameters of women with preeclampsia to a group of healthy normotensive women enrolled as controls with a ratio 1:2. Cardiac Output (CO), Systemic Vascular Resistance (SVR) and Stroke Volume (SV) were compared among controls and preeclamptic women who were grouped in accordance to the following characteristics: Early preeclampsia (<34 weeks gestation) vs late preeclampsia (>34 weeks gestation) onset; Preeclampsia associated with Appropriate for Gestational Age (AGA) or SGA newborns. Hemodynamic characteristics were also compared between preeclamptic women with a mild form vs those who progressed towards a severe form.\n\n\nRESULTS\nA total of 38 preeclamptic women and 61 normotensive women were included in the study. Both cases of preeclampsia associated with SGA neonates as those with normal sized ones showed higher SVR compared to control group (respectively 1580.6±483.2 vs. 1479.1±433.3 vs. 1105.3±293.1; p<0.0001) while a lower CO was reported only for preeclamptic women with SGA neonates compared to controls (5.7±1.5 vs. 6.5±1.3; p=0.02). Maternal cardiac parameters were comparable between these two groups of preeclamptic women (SGA vs. AGA preeclampsia) with the exception a lower stroke volume in the former one (64.8±24.4 vs. 75.2±17.8; p=0.04). Similarly, women with both early and late preeclampsia showed higher SVR compared to controls (1559.5±528.3 vs. 1488.5±292.9 vs. 1105.3±293.1 respectively; p<0.001), while a lower CO was noted only in the early onset group compared to controls (5.5±1.2 p=0.02). Maternal cardiac findings were similar between women with early vs. late onset preeclampsia. Hemodynamic parameters are significantly different between those women with mild preeclampsia who remained stable compared with those who progressed towards a severe disease. CO Z-Score, SVR Z-Score and Uterine Arteries -Pulsatility Index (PI) Z-Score showed similar sensitivity (80% vs 75% vs 80% respectively) and specificity (73% vs. 73% vs. 74%, respectively), while the association of SVR Z-Score and Uterine Arteries PI Z-Score showed a sensitivity of 95% and a specificity of 80% (AUC 0.90) in predicting evolution towards severe forms.\n\n\nCONCLUSIONS\nEvaluation of maternal cardiovascular system could help clinician in defining a subset of preeclamptic patients with more profound placental impairment and might predict the likelihood of progression towards a severe condition in cases with a mild preeclampsia at clinical onset.