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Cardiac function in pre-eclampsia

Michael C Honigberg, Michael M Givertz
Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Although the complete pathophysiology of peripartum cardiomyopathy remains unclear, research over the past decade suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility...
January 30, 2019: BMJ: British Medical Journal
Elisa Llurba Olive, Emily Xiao, David R Natale, Steven A Fisher
Low oxygen concentration (hypoxia) is part of normal embryonic development, yet the situation is complex. Oxygen (O2 ) is a janus gas with low levels signaling through hypoxia-inducible transcription factor (HIF) that are required for development of fetal and placental vasculature and fetal red blood cells. This results in coupling of fetus and mother around midgestation as a functional feto-placental unit (FPU) for O2 transport, which is required for continued growth and development of the fetus. Defects in these processes may leave the developing fetus vulnerable to O2 deprivation or other stressors during this critical midgestational transition when common septal and conotruncal heart defects (CHDs) are likely to arise...
December 1, 2018: Birth defects research
Zahra Hoodbhoy, Babar Sultan Hasan, Nuruddin Mohammed, Devyani Chowdhury
INTRODUCTION: Pre-eclampsia is a common disorder associated with serious maternal and fetal complications. It is associated with abnormal placentation, which significantly reduces flow, resulting in a relative hypoxic state. These pathophysiological changes lead to subtle macrovascular and cardiac structural and functional changes in the fetus. This can predispose the child with maternal history of pre-eclampsia to risk of premature cardiovascular disease. METHODS AND ANALYSIS: The children will be identified from a cohort of women with pre-eclampsia...
September 26, 2018: BMJ Open
Jasmine Tay, Giulia Masini, Carmel M McEniery, Dino A Giussani, Caroline J Shaw, Ian B Wilkinson, Phillip R Bennett, Christoph C Lees
BACKGROUND: The mechanism underlying fetal-placental Doppler index changes in preeclampsia and/or fetal growth restriction are unknown, although both are associated with maternal cardiovascular dysfunction. OBJECTIVE: We sought to investigate whether there was a relationship between maternal cardiac output and vascular resistance and fetoplacental Doppler findings in healthy and complicated pregnancy. STUDY DESIGN: Women with healthy pregnancies (n=62), preeclamptic pregnancies (n=13), preeclamptic pregnancies with fetal growth restriction (n=15), or fetal growth restricted pregnancies (n=17) from 24-40 weeks gestation were included...
January 2019: American Journal of Obstetrics and Gynecology
J Tay, A Costanzi, K Basello, G Piuri, E Ferrazzi, A F Speciani, C C Lees
OBJECTIVES: The objective of this study was the analysis of B-Cell Activating Factor (BAFF) levels in pregnancies affected by PE, and in pregnancies affected by fetal growth restriction without Hypertensive disorders and its possible correlation with pulse wave velocity and cardiac output. STUDY DESIGN: Prospective study of 69 women at 24-40 weeks gestation. Haemodynamic function was assessed in those with Pre-eclampsia (PE, n = 19), fetal growth restriction (FGR, n = 10) and healthy pregnancies (n = 40)...
July 2018: Pregnancy Hypertension
Arthur Jason Vaught, Lara C Kovell, Linda M Szymanski, Susan A Mayer, Sara M Seifert, Dhananjay Vaidya, Jamie D Murphy, Cynthia Argani, Anna O'Kelly, Sarah York, Pamela Ouyang, Monica Mukherjee, Sammy Zakaria
BACKGROUND: Pre-eclampsia with severe features (PEC) is a pregnancy-specific syndrome characterized by severe hypertension and end-organ dysfunction, and is associated with short-term adverse cardiovascular events, including heart failure, pulmonary edema, and stroke. OBJECTIVES: The authors aimed to characterize the short-term echocardiographic, clinical, and laboratory changes in women with PEC, focusing on right ventricular (RV) systolic pressure (RVSP) and echocardiographic-derived diastolic, systolic, and speckle tracking parameters...
July 3, 2018: Journal of the American College of Cardiology
Jamie L R Romeo, Johanna J M Takkenberg, Jolien W Roos-Hesselink, Milad Hanif, Jerome M J Cornette, Wouter J van Leeuwen, Arie van Dijk, Ad J J C Bogers, M Mostafa Mokhles
BACKGROUND: There is no published evidence on pregnancy after right ventricular outflow tract (RVOT) reconstruction with an allograft. OBJECTIVES: The aim of this study was to describe pregnancy outcomes in women with allografts in the RVOT position. METHODS: A retrospective cohort study of consecutive female patients who received allografts in the RVOT position was conducted. All patients between 18 and 50 years of age were screened for cardiac, obstetric, and fetal outcomes of completed (≥20 weeks' gestation) pregnancies...
June 12, 2018: Journal of the American College of Cardiology
Nicole M Ventura, Terry Y Li, M Yat Tse, Logan Richard, Chandrakant Tayade, Albert Y Jin, R David Andrew, Stephen C Pang
Pregnancy evokes many challenges on the maternal cardiovascular system that may unmask predispositions for future disease. This is particularly evident for women who develop pregnancy-related disorders, for example, pre-eclampsia and gestational diabetes or hypertension. Such pregnancy-related syndromes increase the risk for cardiovascular disease (CVD) postpartum. As a result, pregnancy has been termed as a cardiovascular stress test and an indicator or marker to predict the development of CVD later in life...
December 2018: Molecular and Cellular Biochemistry
Jasmine Tay, Lin Foo, Giulia Masini, Phillip R Bennett, Carmel M McEniery, Ian B Wilkinson, Christoph C Lees
BACKGROUND: Preeclampsia and fetal growth restriction are considered to be placentally mediated disorders. The clinical manifestations are widely held to relate to gestation age at onset with early- and late-onset preeclampsia considered to be phenotypically distinct. Recent studies have reported conflicting findings in relation to cardiovascular function, and in particular cardiac output, in preeclampsia and fetal growth restriction. OBJECTIVE: We conducted this study to examine the possible relation between cardiac output and peripheral vascular resistance in preeclampsia and fetal growth restriction...
May 2018: American Journal of Obstetrics and Gynecology
R Orabona, E Vizzardi, E Sciatti, F Prefumo, I Bonadei, A Valcamonico, M Metra, T Frusca
OBJECTIVE: To evaluate maternal hemodynamics in asymptomatic women with a previous pregnancy affected by hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and compare the findings to those of women with previous pre-eclampsia (PE) and controls with a previous uncomplicated pregnancy. METHODS: Women with a history of PE (n = 60) or HELLP syndrome (n = 49) and matched healthy controls (n = 60) underwent echocardiography at 6 months to 4 years after delivery, recording left ventricular (LV) dimensions, ejection fraction (LVEF) and mass, right ventricular (RV) tricuspid annular plane systolic excursion and fractional area change (FAC)...
October 2017: Ultrasound in Obstetrics & Gynecology
P Soma-Pillay, M C Louw, A O Adeyemo, J Makin, R C Pattinson
BACKGROUND: Pre-eclampsia is associated with significant changes to the cardiovascular system during pregnancy. Eccentric and concentric remodelling of the left ventricle occurs, resulting in impaired contractility and diastolic dysfunction. It is unclear whether these structural and functional changes resolve completely after delivery. AIMS: The objective of the study was to determine cardiac diastolic function at delivery and one year post-partum in women with severe pre-eclampsia, and to determine possible future cardiovascular risk...
January 2018: Cardiovascular Journal of Africa
Rachel J Skow, Emily C King, Craig D Steinback, Margie H Davenport
During healthy pregnancy, the cardiovascular system undergoes diverse adaptations to support adequate transfer of oxygen and nutrients from mother to fetus. In order to accommodate the large expansion of blood volume and associated cardiac output, the structure, mechanics, and function of the arteries are altered. Specifically, in healthy pregnancy there is a remodeling of arteries (increased angiogenesis and vasodilation), a generalized reduction in arterial stiffness (increased compliance), and an enhanced endothelial function...
September 1, 2017: Clinical Science (1979-)
N M Breetveld, C Ghossein-Doha, J van Neer, M J J M Sengers, L Geerts, S M J van Kuijk, A P van Dijk, M J van der Vlugt, W M Heidema, H P Brunner-La Rocca, R R Scholten, M E A Spaanderman
OBJECTIVES: Pre-eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure Stage B (HF-B). In this study, we assessed the relationship between endothelial function, measured by flow-mediated dilation (FMD), and HF-B in women with a history of PE. METHODS: This was an observational study in which 67 formerly pre-eclamptic women (≥ 4 years postpartum) and 37 healthy parous controls were assessed ultrasonographically for cardiac function and geometry, as well as for endothelial function by means of brachial artery FMD...
August 2018: Ultrasound in Obstetrics & Gynecology
Stefan Verlohren, Frank H Perschel, Baskaran Thilaganathan, Lisa Antonia Dröge, Wolfgang Henrich, Andreas Busjahn, Asma Khalil
Angiogenic and antiangiogenic factors have proven to be an accurate predictive means of preeclampsia. Echocardiographic studies have shown that women with preeclampsia exhibit significant cardiovascular strain, especially early-onset preeclampsia. The aim of this study is to determine preeclampsia risk with soluble fms-like tyrosin kinase 1/placental growth factor ratio, serum NT-proBNP (N-terminal pro B-type natriuretic peptide), and biophysical markers of cardiovascular function in a prospective case-control study...
June 2017: Hypertension
V T M Borges, S G Zanati, M T S Peraçoli, J R Poiati, M Romão-Veiga, J C Peraçoli, B Thilaganathan
OBJECTIVE: Pre-eclampsia (PE) is associated with maternal cardiac remodeling and diastolic dysfunction. The aim of this study was to assess and compare maternal left ventricular structure and diastolic function and levels of brain natriuretic peptide (BNP) in women with early-onset (< 34 weeks' gestation) vs those with late-onset (≥ 34 weeks' gestation) PE. METHODS: This was a prospective, cross-sectional, observational study of 30 women with early-onset PE, 32 with late-onset PE and 23 normotensive controls...
April 2018: Ultrasound in Obstetrics & Gynecology
Nina D Paauw, Jaap A Joles, Frank T Spradley, Bhavisha Bakrania, Zsuzsanna K Zsengeller, Arie Franx, Marianne C Verhaar, Joey P Granger, A Titia Lely
Women with a history of preeclampsia (PE) have an increased risk to develop cardiovascular and renal diseases later in life, but the mechanisms underlying this effect are unknown. In rats, we assessed whether placental ischemia results in long-term effects on the maternal cardiovascular and renal systems using the reduced uterine perfusion pressure (RUPP) model for PE. Sprague-Dawley rats received either a Sham or RUPP operation at gestational day 14 The rats were followed for 8 wk after delivery (Sham n = 12, RUPP n = 21) at which time mean arterial pressure (MAP; conscious), 24-h albuminuria, glomerular filtration rate (GFR; transcutaneous, FITC-sinistrin), and cardiac function (Vevo 770 system) were assessed...
May 1, 2017: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
I E Bhorat, J S Bagratee, T Reddy
OBJECTIVE: To determine whether fetuses in severe early onset pre-eclampsia (EO-PET) with or without intrauterine growth restriction has cardiac dysfunction across deteriorating stages of placental vascular resistance and whether this dysfunction influences perinatal outcome. STUDY DESIGN: This was a prospective cross-sectional study performed in a tertiary care university medical centre. Sixty pregnant patients with severe early-onset pre-eclampsia between 27 and 32 weeks were recruited and matched with 60 patients having normal pregnancies...
March 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Ira M Bernstein, Sarah A Hale, Gary J Badger, Carole A McBride
OBJECTIVE: The objective of the current study was to evaluate cardiovascular function; including blood pressure, cardiac output, pulse wave velocity and vascular compliance in nonpregnant nulliparous women compared to women with a history of preterm preeclampsia. STUDY DESIGN: This was a case control study. Blood pressure was measured using the Finapres Pro. Baseline cardiac output was determined by echocardiography. Pulse wave velocity was estimated using simultaneous electrocardiographic tracings and ultrasound determined arterial flow waveforms and calculated as estimated distance divided by the time interval between EKG r-wave peak and ultrasound derived peak popliteal artery flow...
October 2016: Pregnancy Hypertension
Hui Li, Yue Zhang, Qingyu Wu
PURPOSE OF REVIEW: Corin is a transmembrane protease that activates atrial natriuretic peptide (ANP), an important hormone in regulating salt-water balance and blood pressure. This review focuses on the regulation of corin function and potential roles of corin defects in hypertensive, heart, and renal diseases. RECENT FINDINGS: Proprotein convertase subtilisin/kexin-6 has been identified as a primary enzyme that converts zymogen corin to an active protease. Genetic variants that impair corin intracellular trafficking, cell surface expression, and zymogen activation have been found in patients with hypertension, cardiac hypertrophy, and pre-eclampsia...
March 2017: Current Opinion in Nephrology and Hypertension
I Bhorat, D P Naidoo, J Moodley
AIM: To establish alterations in maternal cardiac haemodynamics and function using electrocardiography and echocardiography in severe pre-eclampsia complicated by acute pulmonary oedema. METHODS: An extensive literature search including any research articles, randomised control trials, observational study, case report or expert or consensus statement pertaining to severe pre-eclampsia, eclampsia, hypertensive crises of pregnancy, pulmonary oedema, maternal cardiac haemodynamics, Holter monitoring and maternal echocardiography was done...
December 2017: Journal of Maternal-fetal & Neonatal Medicine
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