Pre-eclampsia and long-term cardiac dysfunction: A review of asymptomatic cardiac changes existing well beyond the post-partum period

Archana S Thayaparan; Joanne M Said; Sandra A Lowe; Anthony McLean; Yang Yang

doi:10.1002/ajum.12173

Pre-eclampsia and long-term cardiac dysfunction: A review of asymptomatic cardiac changes existing well beyond the post-partum period

Australas J Ultrasound Med. 2019 Jul 2;22(4):234-244. doi: 10.1002/ajum.12173. eCollection 2019 Nov.

Authors

Archana S Thayaparan¹, Joanne M Said², Sandra A Lowe³, Anthony McLean⁴, Yang Yang⁵

Affiliations

¹ Western Health St Albans Victoria Australia.
² Joan Kirner Women's and Childrens Hospital St Albans Victoria Australia.
³ Royal Hospital for Women Randwick New South Wales Australia.
⁴ Nepean Hospital Kingswood New South Wales Australia.
⁵ Western Health, Eastern Health Epworth Hospital Victoria Australia.

Abstract

Background: Pre-eclampsia is a disease of pregnancy characterised by the manifestations of multi-organ dysfunction. The recent use of transthoracic echocardiography in the assessment of women with pre-eclampsia has allowed the detection of cardiac systolic and diastolic dysfunction in the acute phase. Women with a history of pre-eclampsia also have increased lifelong risks of cardiovascular disease and mortality that persists well beyond the post-partum period. These developments raise the possibility that pre-eclampsia may be an early marker of cardiovascular disease and the potential role for echocardiography in guiding the detection and management of this. This review aims to summarise the existing evidence of echocardiographic cardiac assessment of women with a history of pre-eclampsia performed more than 12 weeks post-partum.

Methods: A systematic search of PubMed and OVID EMBASE databases was performed to identify studies featuring assessment of cardiac function performed after 12 weeks post-partum in women with a history of pre-eclampsia. Studies without post-partum cardiac assessment or with other documented causes for cardiomyopathy were excluded.

Results: Thirteen studies were identified that measured cardiac function by transthoracic echocardiography between 6 months and 18 years following a pregnancy complicated by pre-eclampsia. Common findings across the studies were of increased diastolic dysfunction, increased left ventricular mass index (LVMI) and concentric hypertrophy in women with a history of pre-eclampsia, as compared to women with uncomplicated pregnancy histories. This was predominantly seen in those with a history of early or preterm pre-eclampsia.

Conclusions: Women with a history of early or preterm pre-eclampsia have an increased prevalence of diastolic dysfunction. This review demonstrates that the cardiac dysfunction associated with previous pre-eclampsia is quantifiable and persistent. Progression of heart failure from asymptomatic to symptomatic stages carries a fivefold increase in mortality. The use of echocardiography could detect cardiac dysfunction in the asymptomatic stage and guide more intensive risk factor modification in these women.

Keywords: cardiac; echocardiography; heart disease; pregnancy; pre‐eclampsia; ultrasound.

Publication types

Review