Cardiac maladaptation in term pregnancies with preeclampsia

Objectives:
To study biventricular cardiac changes with conventional echocardiography and new echocardiographic speckle tracking technologies such strain, twist and torsion in pregnant women with preeclampsia at term and normotensive control term pregnant women.

Study design:
For this prospective single centre case-control study, we consecutively recruited 30 women with preeclampsia at term as cases and 40 healthy control term pregnant women. All women underwent transthoracic echocardiographic examination at the time point of inclusion into the study.

Main outcome measures:
Signs of systolic and/or diastolic cardiac maladaptation to the increased volume load associated with pregnancy.

Results:
Conventional echocardiography revealed mild left sided diastolic impairment in the form of significantly increased E/E' in preeclampsia (7.58 ± 1.72 vs. 6.18 ± 1.57, p = 0.001) compared to normotensive controls, but no evidence of systolic impairment. With speckle tracking analysis, significant decreases in left ventricular global (−13.32 ± 2.37% vs. −17.61 ± 1.89%, p < 0.001), endocardial (−15.64 ± 2.79% vs. −19.84 ± 2.35%, p < 0.001) and epicardial strain (−11.48 ± 2.15% vs. −15.73 ± 1.66%, p < 0.001) as well as left ventricular longitudinal strain rate (−0.84 ± 0.14 s−1 vs. −0.98 ± 0.12 s−1, p < 0.001) and left ventricular early diastolic strain rate (0.86 ± 0.30 s−1 vs. 1.24 ± 0.26 s−1, p < 0.001) could be observed in women with term preeclampsia.

Conclusions:
The findings of this study demonstrate that pregnant women with term preeclampsia with minimal functional changes on conventional echocardiography, demonstrated significant subclinical myocardial changes on speckle tracking analysis.