Alterations in cardiac function in women with severe preeclampsia: return to normal in one year after delivery?

Abstract

\n \n \n Type of funding sources: None.\n Introduction.\xa0In peri-partum period women with preeclampsia have demonstrated signs of subtle left ventricular (LV) dysfunction. However, there is still controversy if these changes persist or improve late after delivery.\n Purpose. To evaluate LV dimensions and function in severe preeclamptic women and healthy controls immediately post-delivery and 1 year postpartum.\n Methods. The study population comprised 24 women with severe preeclampsia and 15 healthy term controls. All women underwent standard and speckle-tracking echocardiography to assess myocardial function and deformation parameters 1 day after delivery and 1 year postpartum. To examine the impact of preload and afterload on myocardial function LV end-diastolic volume and systolic blood pressure were used accordingly.\n Results. On day 1 post-delivery women with severe preeclampsia were exposed to increased afterload with significantly higher systolic blood pressure compared to controls (147 [136-157] in preeclamptic vs. 112 [102-118] mmHg in control group, p\u2009<\u20090.001). Similarly, preeclamptic women had also higher preload demonstrated with larger LV end-diastolic volume (114 [100-128] vs. 95 [92-102] ml, p\u2009=\u20090.003) and left atrial volume index (36 [33-38] vs. 32 [29-36] ml/m2, p\u2009=\u20090.02) than control group. Among other geometric parameters difference in LV mass index was observed between groups (preeclamptic group: (81 [70-96] vs. control group: 66 [61-74] g/m2, p\u2009=\u20090.01).\n Global systolic parameters (LV ejection fraction and global longitudinal strain) did not differ between groups; however, peak systolic myocardial velocity (s’) was significantly lower in preeclamptic compared to control group (7.6 [6.5-8.1] vs. 8.0 [7.5-8.9] cm/s, p\u2009=\u20090.02) immediately post-delivery. Diastolic function differed between groups with significantly higher E/e’ ratio in preeclamptic women than controls (8.7 [7.6-10.0] vs. 6.9 [6.4-7.8] p\u2009=\u20090.01) one day post-delivery.\n One year after delivery both groups had normal and similar arterial blood pressure and there were no differences in geometric, systolic and diastolic function parameters between groups (Figure A-D).\xa0\n Conclusions. Our results showed that women with severe preeclampsia had subtle cardiac dysfunction immediately post-delivery compared to healthy controls and recovered completely in one year after delivery. Subtle cardiac dysfunction in preeclampsia immediately post-delivery seemed to be related or unmasked by pronounced changes in loading conditions, which resolved in mid-term postpartum period. Long-term follow-up with larger study population is needed to identify subgroup of women who have persistent subclinical cardiac alterations and experience cardiovascular events later in life.\n Abstract Figure\n