Cardiac structure and function in women with preeclampsia: a systematic review and meta analysis
J Yao, C Wong, B Wang, A Browne, S Peters, A J Taylor, S Brennecke, I Winship, D ZentnerAbstract
Aim
Preeclampsia (PE) affects around 2-4% of all pregnancies globally and is associated with significant maternal and fetal morbidity and mortality. PE is now an established risk factor for future cardiovascular disease, including a 4-fold increased risk of heart failure (HF)(1). Unfortunately, however, universal guidelines for postpartum HF surveillance are lacking in this high-risk group(2). Stage B/ subclinical HF has been shown to predict risk of major adverse cardiac outcomes(3). Some suggest that initiating cardioprotective therapy at this early stage can reduce progression to symptomatic HF. The aim of this review was to explore cardiac structure and function in women with a history of PE and to identify if and when subclinical HF develops in this group.
Method
A systematic search of MEDLINE, EMBASE and CINAHL was conducted according to PRISMA guidelines to identify all studies which reported measures of LV structure and function on transthoracic echocardiography (TTE) in women with a history of PE.
Results
45 case-control studies comprising 8,991 women including 2,288 women with a history of PE, were included in the final analysis. During pregnancy, women with PE had a higher LVMI (SMD 10.85 (95% CI 6.30, 15.39)), RWT (SMD 0.05 (95% CI 0.03, 0.08)), E/e’ (SMD 1.58 (95% CI 1.02, 2.13)), IVRT (SMD 8.74 (95% CI 3.14, 14.34)), lower E/A ratio (SMD -0.27 (95% CI -0.51, -0.04)) and lower GLS (SMD 2.27 (95% CI 0.43, 4.11)) compared to normotensive controls. Postpartum, GLS remained lower in women with a history of PE (SMD 2.43 (95% CI 1.26, 3.61)) and this difference persisted out to 10 years postpartum (SMD 2.19 (95% CI 0.03, 4.36)). There was no significant difference in all other variables postpartum. LVEF and RV function remained similar in the PE and control groups antenatally and postnatally.
Conclusion
Our review suggests that a history of PE is associated with subclinical heart dysfunction, as determined by GLS. Compared to those with normotensive pregnancies, those with PE had reduced GLS during pregnancy and this difference persisted out to 10 years postpartum. Further studies are required to assess when subclinical HF progresses to symptomatic clinical HF and to determine factors which influence this progression.