Identifying Early Markers of Cardiac Dysfunction in Pregnancy Essay
LAS VEGAS (Jan. 23, 2017)—In a study to be presented Friday, Jan. 27, in the oral concurrent session at 1:15 p.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, researchers with the Maternal and Child Health Research Center and the Department of Cardiology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, will present findings of a study titled Cardiac Dysfunction in Preeclampsia is Present at Diagnosis and Persists Postpartum.
Preeclampsia, which affects 3-8 percent of all pregnancies, is a disease specific to pregnancy that is characterized by high blood pressure and protein in the urine. Research studies have clearly shown that there is a link between a history of preeclampsia in a pregnancy and developing heart disease later in life. In fact, a history of preeclampsia is as much of a risk factor for heart disease as a lifetime of smoking cigarettes and the American Heart Association now screens women specifically for a history of preeclampsia. The issue is that, while this association is clearly known, not all women with a history of preeclampsia will develop heart disease. Additionally, we do not know the exact process that takes place from the time women experience preeclampsia to the ultimate development of heart disease.
This research looked at women with and without preeclampsia in a pregnancy and performed echocardiograms on them (ultrasounds of the heart) to see if they could identify which women are at highest risk of developing heart disease later in life by identifying early signs (during the pregnancy and within the six weeks postpartum) of an abnormal heart. Since the majority of heart disease does not occur until decades after experiencing preeclampsia, identifying early cardiac changes could potentially lead to early interventions that decrease the long-term risk.
Lisa Levine, M.D., MSCE, assistant professor of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania, and the presenter of the study at the SMFM annual meeting, explained, “Specifically for women with preeclampsia – the study has shown that there are signs of heart changes that can be identified in these women as early as the time they are diagnosed with the condition and identifies the importance of close follow-up of these women to ensure appropriate heart health for the future.”
Studies have shown that African-American women are at a higher risk of preeclampsia as well as a higher risk of heart disease. Because a large population of the researchers’ institution patients are African-American, they made up more than 80 percent of the study. Researchers also noted that preeclampsia disproportionately affects African-American women compared to other races and therefore is one of the reasons for the high percentage in the study.
About the Society for Maternal-Fetal Medicine
The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.
Abstract 61 Cardiac dysfunction in preeclampsia is present at diagnosis and persists postpartum
Lisa Danielle Levine¹ , Katheryne L. Downes¹ , Zolt Arany² , Bonnie Ky² , Michal A. Elovitz¹ ¹Maternal and Child Health Research Program; University of Pennsyvlania Perelman School of Medicine, Philadelphia, PA, ²Department of Cardiology; University of Pennsyvlania Perelman School of Medicine, Philadelphia, PA
OBJECTIVE: Preeclampsia (PEC) is a known risk factor for long-term cardiovascular disease (CVD), including heart failure. Identifying early markers of cardiac dysfunction is an important step in understanding the pathogenesis by which PEC exposure leads to overt CVD. Sensitive echocardiographic (echo) markers of dysfunction (longitudinal strain, strain rate) have been associated with adverse outcomes in non-pregnant women. Our objective was to investigate whether PEC is associated with these echocardiographic markers of dysfunction at the time of diagnosis and if this dysfunction persists in the peripartum period.
STUDY DESIGN: A prospective longitudinal cohort study was performed from April 2015-May 2016 evaluating echo changes in women with severe preterm (23w0d-36w6d) PEC. Findings were compared to unexposed controls without PEC matched by gestational age (GA), maternal age, race, and BMI. Echos were obtained at time of diagnosis (baseline) and 6 weeks postpartum. Conventional as well as sensitive measures of systolic and diastolic function were quantitated from 2D and Doppler echo. Indices of total arterial load were derived from blood pressure and stroke volume. Mann Whitney-U tests were used to compare data.
RESULTS: The average GA at baseline was 31 weeks and 82.4% were African American. Longitudinal strain and strain rate (sensitive markers of systolic dysfunction) were significantly worsened in cases vs. controls at time of diagnosis as well as 6 weeks postpartum, despite a preserved ejection fraction, see Table. Additional echo markers of dysfunction were also found to be significantly altered in cases compared to controls at baseline and 6 weeks postpartum including diastolic dysfunction and arterial load, Table.
CONCLUSION: These findings suggest that women with severe PEC have early evidence of cardiac dysfunction that persists for at least 6 weeks postpartum. Identifying early cardiac dysfunction among women with severe PEC is a critical step in providing opportunities for risk stratification and early intervention to decrease the associated risk of long term CVD in this high-risk group of women.