1,721,023 research outputs found
Atherosclerosis after pre-eclampsia: systematic review and meta-analysis
No full textObjective Pre-eclampsia complicates up to 8% of pregnancies and is associated with increased risk of ischemic cardiac and cerebral disease, which may be prevented through management of cardiovascular risk when early disease stages are detected. This meta-analysis aimed to determine the prevalence of clinical and subclinical atherosclerosis in women after pre-eclamptic vs non-pre-eclamptic pregnancy with advancing maternal age.Methods A systematic search of the literature was conducted in PubMed, Embase and Web of Science for studies reporting on the prevalence of atherosclerosis in women with a previous pre-eclamptic pregnancy and those with a previous uncomplicated pregnancy. Any systemic atherosclerosis documented using ultrasound or computed tomography was included. Random-effects meta-analysis was used to compute the odds ratio (OR) with 95% CI for the association between pre-eclampsia and the presence of atherosclerosis. Subgroup analysis was conducted according to average maternal age at evaluation.Results A total of 11 articles were included (13 217 participants). The average maternal age at evaluation ranged from 32 to 60 years. Within this age range, the pooled OR for the presence of atherosclerotic plaque after pre-eclampsia was 1.57 (95% CI, 1.39-1.78). The pooled OR of developing atherosclerotic plaque after a pre-eclamptic vs non-pre-eclamptic pregnancy increased gradually with advancing maternal age. The OR was not significant in the 30-39-year-old group (0.64 (95% CI, 0.10-4.15)), but the odds of finding an atherosclerotic plaque were significantly increased after pre-eclamptic pregnancy in the 40-49-year-old group (OR, 1.59 (95% CI, 1.34-1.89)) and 50-60-year-old group (OR, 2.00 (95% CI, 1.30-3.08)). At any given age, the percentage plaque prevalence in formerly pre-eclamptic women was roughly equal to that seen 10 years later in women with a previous non-pre-eclamptic pregnancy.Conclusions Women with a previous pre-eclamptic pregnancy exhibit atherosclerosis more frequently and approximately 10 years earlier compared with women with a previous non-pre-eclamptic pregnancy. Targeted primary prevention is required to reduce morbidity and mortality from premature cardiovascular disease in women after pre-eclampsia. (c) 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.ACKNOWLEDGMENT
We thank Dr Marieke Schor from Maastricht University for her help with setting up the systematic search.
Disclosure
Grant funding was received from the Dutch Heart Foundation (grant number: 02-001-2023-0141). A.v.H. declares receipt of grant funding from Boehringer Ingelheim, Abbott Vascular and Sanofi. In addition, his institution received consulting fees from Celecor Therapeutics. Furthermore, A.v.H. is on the Data and Safety Monitoring Board (DSMB) for the COMBINE-INTERVENE trial and is a chairperson for the Dutch Guideline Committee on Cardiac Rehabilitation
Inappropriate left ventricular mass after HELLP syndrome inappropriate LVM after HELLP syndrome
No full textObjectives: Excessive left ventricular mass (LVM) results in inefficient LV work with energy waste leading to a negative prognostic effect. We aimed at investigating the presence of inappropriate LVM and calculating the myocardial mechano-energetic efficiency index (MEEi) in former pre-eclamptic (PE) women (with or without HELLP syndrome) compared to women who experienced HELLP syndrome without PE. Study design: In this cross-sectional study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent echocardiography as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity. Main outcome measures: LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was considered as the ratio between stroke work and “double product” (to approximate energy consumption), indexed to LVM. Results: LV hypertrophy was present in 8–14% and concentric remodeling in 31–42% of women, without intergroup difference. LVM was inappropriate in one-third of normotensive former HELLP and in about one-half of PE with or without HELLP, with no difference among groups. Accordingly, without nominal difference, MEEi showed a tendency towards lower values in former pre-eclamptic individuals. Conclusions: Women with a history of HELLP syndrome, independently from the presence/absence of PE, showed inappropriate LVM in the first 4 years after delivery, which may partially explain the elevated CV risk in these women compared to the general female population
Maternal myocardial dysfunction after hemolysis, elevated liver enzymes, and low platelets syndrome: a speckle-tracking study
No full textOBJECTIVES: Pregnancy complicated by pre-eclampsia (PE) and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is associated with an increased risk of cardiovascular (CV) diseases later in life. Subclinical cardiac alterations precede eminent CV diseases. Speckle-tracking echocardiography (STE) is an effective method to assess subclinical myocardial dysfunction. We performed a myocardial speckle tracking study to investigate the prevalence of subclinical myocardial dysfunction in former PE patients (with and without HELLP syndrome) compared to normotensive women affected by HELLP syndrome. METHODS: In this cross-sectional retrospective study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent conventional and STE as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity. RESULTS: Women with a history of PE with HELLP syndrome were characterized by a higher prevalence of altered left ventricular circumferential and global longitudinal two-dimensional (2D) strain (74 and 20%, respectively), altered right ventricular longitudinal 2D strain (37%), and left atrial (LA) 2D strain (57%). Moreover, a higher proportion of alterations of biventricular and LA strains was also present in former PE without HELLP as well as in the normotensive HELLP group. CONCLUSIONS: In the first years after a pregnancy complicated by HELLP syndrome, irrespective of whether there was concomitant PE, a higher rate of abnormal STE myocardial function is observed. Therefore, these women may benefit from CV risk management
Inappropriate left ventricular mass after preeclampsia: another piece of the puzzle Inappropriate LVM and PE
No full textMaternal myocardial dysfunction after normotensive fetal growth restriction compared with hypertensive pregnancies: a speckle-tracking study
No full textOBJECTIVE: Pregnancy complicated by preeclampsia and fetal growth restriction (FGR) relates to increased risk of cardiovascular disease later in life, but to different extents. Subclinical cardiac alterations precede eminent cardiovascular disease. Speckle-tracking echocardiography is an elegant method to assess subclinical myocardial dysfunction. We performed a myocardial speckle tracking study to evaluate the prevalence of subclinical myocardial dysfunction in former preeclampsia patients (with and without FGR) compared with normotensive women with FGR. METHODS: For this cross-sectional study, we retrospectively selected women with a history of normotensive FGR (n = 17), preeclampsia with FGR (n = 26) and preeclampsia without FGR (n = 134) who underwent conventional echocardiography as part of the clinical cardiovascular work-up after complicated pregnancies between 6 months and 4 years postpartum in Maastricht, The Netherlands. We excluded women with chronic hypertension, hypercholesterolemia and obesity. RESULTS: Women with normotensive FGR showed subclinical left ventricular (LV) impairment in systodiastolic function with concentric remodeling, slight alteration in right ventricular systolic function and left atrial strain, similarly to the preeclampsia group independently from the fetal growth. LV hypertrophy was only present in about 10% of cases who experienced preeclampsia (independently from the fetal growth) but not in those with normotensive FGR. CONCLUSION: Similar to women with a history preeclampsia, women with a history of normotensive pregnancy but with FGR have abnormal myocardial function, shown with speckle-tracking echocardiography. Therefore, both preeclampsia and normotensive FGR should be viewed upon as risk indicator for subclinical myocardial impairment that may benefit from cardiovascular risk management
ISUOG Consensus Statement on maternal hemodynamic assessment in hypertensive disorders of pregnancy and fetal growth restriction
Get PDFPregnancy presents a unique cardiovascular challenge. Profound maternal hemodynamic adjustments result from a complex interplay between the maternal cardiovascular system and uteroplacental perfusion, which permits fetal development while maintaining healthy maternal homeostasis. Failure to meet this challenge can lead to maternal hypertensive complications (hypertensive disorders of pregnancy (HDP)) and/or fetal growth disorders (fetal growth restriction (FGR)).
Monitoring and management of HDP and FGR has been based largely on maternal blood pressure (BP) monitoring and fetal growth assessment. Promising research offers the prospect of a less reactive and more proactive approach. Maladaptation to the requirements of pregnancy can be detected in a preclinical phase of HDP and FGR by maternal hemodynamic assessment, offering opportunities for targeted hemodynamic interventions. Pregnancy also serves as a stress test for future cardiovascular health, especially if superimposed upon subclinical cardiometabolic or cardiovascular vulnerabilities.
This Consensus Statement provides an update on the role of maternal hemodynamic assessment in HDP and FGR
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