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Ultrasound Obstet Gynecol. 2017 Jan;49(1):143-149. doi: 10.1002/uog.17343.

Pre-eclampsia: an important risk factor for asymptomatic heart failure.

Author information

1
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
2
Department of Cardiology, MUMC, Maastricht, The Netherlands.
3
Department of Cardiology, Radboud UMC, Nijmegen, The Netherlands.
4
Department of Internal Medicine, Radboud UMC, Nijmegen, The Netherlands.
5
Department of Obstetrics and Gynaecology, Radboud UMC, Nijmegen, The Netherlands.

Abstract

OBJECTIVES:

Pre-eclampsia (PE) is associated with both postpartum structural asymptomatic heart disease (i.e. heart failure Stage B (HF-B)) and conventional cardiovascular (CV) risk factors. We aimed to evaluate the extent to which PE, adjusted for conventional CV risk factors, is associated independently with asymptomatic cardiac abnormalities postpartum.

METHODS:

In this cross-sectional cohort study, 107 formerly pre-eclamptic women and 41 women with uneventful previous pregnancy (controls) were invited for CV risk assessment 4-10 years postpartum. This included cardiac ultrasound, blood pressure (BP) measurement and evaluation of metabolic syndrome determinants. Asymptomatic structural and functional cardiac abnormalities were classified as HF-B, according to the American Heart Association guidelines. Prehypertension was defined as systolic BP of 120-139 mmHg and/or diastolic BP of 80-89 mmHg. Univariate and multivariate regression analyses were performed to calculate associations of PE and conventional risk factors with HF-B.

RESULTS:

The prevalence of asymptomatic HF-B was approximately 3.5-fold higher in the PE group compared with controls (25% vs 7%, P < 0.01); 67% of this group had concentric remodeling and 22% had mildly impaired ejection fraction. After adjustment for postpartum interval, hypertension and high-density lipoprotein, PE was significantly associated with HF-B (adjusted odds ratio, 4.4 (95% CI, 1.0-19.1)). Moreover, in the formerly pre-eclamptic group, prehypertension was associated significantly with HF-B (odds ratio, 4.3 (95% CI, 1.4-12.7)), while metabolic syndrome determinants were not.

CONCLUSION:

PE is associated with a four-fold increased female-specific risk of asymptomatic cardiac abnormalities. Prehypertension apparently increases this risk significantly, while metabolic syndrome determinants do not. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

KEYWORDS:

heart failure; metabolic syndrome; pre-eclampsia; pregnancy; prehypertension

PMID:
27804179
DOI:
10.1002/uog.17343
[Indexed for MEDLINE]
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