TY - JOUR
T1 - Inappropriate left ventricular mass after preeclampsia
T2 - another piece of the puzzle Inappropriate LVM and PE
AU - Orabona, Rossana
AU - Sciatti, Edoardo
AU - Vizzardi, Enrico
AU - Prefumo, Federico
AU - Bonadei, Ivano
AU - Valcamonico, Adriana
AU - Metra, Marco
AU - Lorusso, Roberto
AU - Ghossein-Doha, Chahinda
AU - Spaanderman, Marc E. A.
AU - Frusca, Tiziana
N1 - Publisher Copyright:
© 2018, The Japanese Society of Hypertension.
PY - 2019/4
Y1 - 2019/4
N2 - Excessive left ventricular (LV) mass (LVM) increase results in inefficient LV work with high energy waste and a negative prognostic effect. We aimed to investigate the presence of inappropriate LVM and to calculate the myocardial mechanoenergetic efficiency index (MEEi) in asymptomatic women with a history of early-onset (EO) or late-onset (LO) pre-eclampsia (PE). Among all women diagnosed with PE in the years 2009-2013, after applying inclusion/exclusion criteria and cost-effectiveness analysis, we randomly selected thirty women who experienced EO-PE, thirty with a previous LO-PE and thirty healthy controls to undergo echocardiography from 6 months to 4 years after delivery. Data regarding gestational age (GA) and mean uterine artery (UtA) pulsatility index (PI) at PE onset were collected from medical records. All women were free from cardiovascular risk factors. LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was calculated as the ratio between stroke work and "double product" (to approximate energy consumption), indexed to LVM. Concentric remodeling was present in 60% of EO-PE and 53% of LO-PE. LVM excess was significantly more often present in the EO-PE group than in the control group. LVM was inappropriate in 52% of EO-PE and 17% of LO-PE. MEEi showed a tendency towards lower values in the EO-PE group. Multivariate regression analysis showed that both LVM excess and MEEi were independently associated with lower GA and higher mean UtA PI at PE onset. Inappropriate LVM with a tendency towards reduced MEEi in the first 4 years after delivery may partially explain the elevated cardiovascular risk in former pre-eclamptic women compared to the general population.
AB - Excessive left ventricular (LV) mass (LVM) increase results in inefficient LV work with high energy waste and a negative prognostic effect. We aimed to investigate the presence of inappropriate LVM and to calculate the myocardial mechanoenergetic efficiency index (MEEi) in asymptomatic women with a history of early-onset (EO) or late-onset (LO) pre-eclampsia (PE). Among all women diagnosed with PE in the years 2009-2013, after applying inclusion/exclusion criteria and cost-effectiveness analysis, we randomly selected thirty women who experienced EO-PE, thirty with a previous LO-PE and thirty healthy controls to undergo echocardiography from 6 months to 4 years after delivery. Data regarding gestational age (GA) and mean uterine artery (UtA) pulsatility index (PI) at PE onset were collected from medical records. All women were free from cardiovascular risk factors. LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was calculated as the ratio between stroke work and "double product" (to approximate energy consumption), indexed to LVM. Concentric remodeling was present in 60% of EO-PE and 53% of LO-PE. LVM excess was significantly more often present in the EO-PE group than in the control group. LVM was inappropriate in 52% of EO-PE and 17% of LO-PE. MEEi showed a tendency towards lower values in the EO-PE group. Multivariate regression analysis showed that both LVM excess and MEEi were independently associated with lower GA and higher mean UtA PI at PE onset. Inappropriate LVM with a tendency towards reduced MEEi in the first 4 years after delivery may partially explain the elevated cardiovascular risk in former pre-eclamptic women compared to the general population.
KW - ENERGETIC EFFICIENCY
KW - HEART
KW - HYPERTENSIVE SUBJECTS
KW - MATERNAL CARDIAC-FUNCTION
KW - MYOCARDIAL OXYGEN-CONSUMPTION
KW - PREGNANCY
KW - Pre-eclampsia
KW - RECOMMENDATIONS
KW - RISK
KW - STROKE VOLUME
KW - WOMEN
KW - echocardiography
KW - inappropriate
KW - left ventricular mass
KW - mechanoenergetic efficiency
KW - remodeling
KW - ASSOCIATION
U2 - 10.1038/s41440-018-0163-9
DO - 10.1038/s41440-018-0163-9
M3 - Article
C2 - 30552407
SN - 0916-9636
VL - 42
SP - 522
EP - 529
JO - Hypertension Research
JF - Hypertension Research
IS - 4
ER -