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- Title
Decreased endothelial function and increased subclinical heart failure in women several years after pre-eclampsia.
- Authors
Breetveld, N. M.; Ghossein‐Doha, C.; van Neer, J.; Sengers, M. J. J. M.; Geerts, L.; van Kuijk, S. M. J.; van Dijk, A. P.; van der Vlugt, M. J.; Heidema, W. M.; Brunner‐La Rocca, H. P.; Scholten, R. R.; Spaanderman, M. E. A.; Ghossein-Doha, C; Brunner-La Rocca, H P
- Abstract
<bold>Objectives: </bold>Pre-eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure Stage B (HF-B). In this study, we assessed the relationship between endothelial function, measured by flow-mediated dilation (FMD), and HF-B in women with a history of PE.<bold>Methods: </bold>This was an observational study in which 67 formerly pre-eclamptic women (≥ 4 years postpartum) and 37 healthy parous controls were assessed ultrasonographically for cardiac function and geometry, as well as for endothelial function by means of brachial artery FMD. HF-B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) > 95 g/m2 ), concentric remodeling (relative wall thickness > 0.42 and LVMi ≤ 95 g/m2 ), mild systolic dysfunction (left ventricular ejection fraction > 40% and < 55%) or asymptomatic valvular disease. Cardiovascular and metabolic syndrome variables were compared between women with history of PE and controls, as well as between those in the formerly pre-eclamptic group who had HF Stage A, HF-B or no HF. Logistic regression analysis was performed to assess the associations of FMD with PE, metabolic syndrome risk factors and obstetric parameters.<bold>Results: </bold>The prevalence of HF-B amongst formerly pre-eclamptic women was three-fold higher than that observed for controls (25% vs 8%, P < 0.05), while FMD was lower in formerly pre-eclamptic women compared with controls (6.12% vs 8.22%, P < 0.01); history of PE remained associated independently with lower FMD after adjusting for metabolic syndrome risk factors and obstetric parameters (β, -1.88; 95% CI, -3.59 to -0.18). However, HF-B did not relate to low FMD in formerly pre-eclamptic women.<bold>Conclusions: </bold>Years after pregnancy, formerly pre- eclamptic women have lower FMD and have HF-B more often compared with healthy parous controls. Nonetheless, HF-B was not related to reduced FMD. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
- Subjects
ENDOTHELIUM physiology; HEART failure risk factors; PREECLAMPSIA; HEART diseases in women; ENDOTHELIUM diseases; DISEASES in women; ARTERIAL physiology; CARDIOVASCULAR diseases risk factors; DISEASE risk factors
- Publication
Ultrasound in Obstetrics & Gynecology, 2018, Vol 52, Issue 2, p196
- ISSN
0960-7692
- Publication type
journal article
- DOI
10.1002/uog.17534