Author + information
- Received February 17, 2018
- Revision received March 23, 2018
- Accepted April 7, 2018
- Published online June 25, 2018.
- Arthur Jason Vaught, MDa,∗∗ (, )@HopkinsMedicine@UMassMedical,
- Lara C. Kovell, MDb,∗,
- Linda M. Szymanski, MD, PhDa,
- Susan A. Mayer, MDc,
- Sara M. Seifert, MDd,
- Dhananjay Vaidya, MBBS, MPH, PhDc,
- Jamie D. Murphy, MDe,
- Cynthia Argani, MDa,
- Anna O’Kelly, BSf,
- Sarah York, BSc,
- Pamela Ouyang, MBBSc,
- Monica Mukherjee, MD, MPHc and
- Sammy Zakaria, MD, MPHc
- aDepartment of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- bDepartment of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- cDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- dDepartment of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- eDepartment of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- fJohns Hopkins University School of Medicine, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Arthur Jason Vaught, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 660 North Wolfe Street, Phipps 228, Baltimore, Maryland 21287.
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.
Methods In this prospective observational study, the authors recruited 63 women with PEC and 36 pregnant control patients.
Results The PEC cohort had higher RVSP (31.0 ± 7.9 mm Hg vs. 22.5 ± 6.1 mm Hg; p < 0.001) and decreased global RV longitudinal systolic strain (RVLSS) (−19.6 ± 3.2% vs. −23.8 ± 2.9% [p < 0.0001]) when compared with the control cohort. For left-sided cardiac parameters, there were differences (p < 0.001) in mitral septal e′ velocity (9.6 ± 2.4 cm/s vs. 11.6 ± 1.9 cm/s), septal E/e′ ratio (10.8 ± 2.8 vs. 7.4 ± 1.6), left atrial area size (20.1 ± 3.8 cm2 vs. 17.3 ± 2.9 cm2), and posterior and septal wall thickness (median [interquartile range]: 1.0 cm [0.9 to 1.1 cm] vs. 0.8 cm [0.7 to 0.9 cm], and 1.0 cm [0.8 to 1.2 cm] vs. 0.8 cm [0.7 to 0.9 cm]). Eight women (12.7%) with PEC had grade II diastolic dysfunction, and 6 women (9.5%) had peripartum pulmonary edema.
Conclusions Women with PEC have higher RVSP, higher rates of abnormal diastolic function, decreased global RVLSS, increased left-sided chamber remodeling, and higher rates of peripartum pulmonary edema, when compared with healthy pregnant women.
- diastolic dysfunction
- pulmonary edema
- right ventricular systolic pressure
- speckle tracking echocardiography
↵∗ Drs. Vaught and Kovell contributed equally to this work and are joint first authors.
This study was funded by a Johns Hopkins University School of Medicine (JHUSOM) Synergy Award. Dr. Vaidya was partially supported by the Johns Hopkins Center for Child and Community Health Research-Biostatistics, Epidemiology and Data Management Core. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Basky Thilaganathan, MD, PhD, served as Guest Editor for this paper.
- Received February 17, 2018.
- Revision received March 23, 2018.
- Accepted April 7, 2018.
- 2018 American College of Cardiology Foundation
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