title: Persistent Maternal Cardiac Dysfunction After Preeclampsia Identifies Patients at Risk for Recurrent Preeclampsia.
abstract: The purpose of our study was to assess cardiac function in nonpregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case-control study and submitted to echocardiographic examination in the nonpregnant state 12 to 18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiographic examination and were followed until term. Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the nonpregnant state, patients with recurrent preeclampsia compared with controls and nonrecurrent preeclampsia had lower stroke volume (63 ± 14 mL versus 73 ± 12 mL and 70 ± 11 mL, P<0.05), cardiac output (4.6 ± 1.2 L versus 5.3 ± 0.9 L and 5.2 ± 1.0 L, P<0.05), higher E/E' ratio (11.02 ± 3.43 versus 7.34 ± 2.11 versus 9.03 ± 3.43, P<0.05), and higher total vascular resistance (1638 ± 261 dyne · s(-1) · cm(-5) versus 1341 ± 270 dyne · s(-1) · cm(-5) and 1383 ± 261 dyne · s(-1) · cm(-5), P<0.05). Left ventricular mass index was higher in both recurrent and nonrecurrent preeclampsia compared with controls (30.0 ± 6.3 g/m(2.7) and 30.4 ± 6.8 g/m(2.7) versus 24.8 ± 5.0 g/m(2.7), P<0.05). Signs of diastolic dysfunction and different left ventricular characteristics are present in the nonpregnant state before a second pregnancy with recurrent preeclampsia. Previous preeclamptic patients with nonrecurrent preeclampsia show left ventricular structural and functional features intermediate with respect to controls and recurrent preeclampsia.
authors.affiliation: From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.). valensise@uniroma2.it.
authors.forename: Herbert
authors.initials: H
authors.lastname: Valensise
authors.affiliation: From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.).
authors.forename: Damiano
authors.initials: D
authors.lastname: Lo Presti
authors.affiliation: From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.).
authors.forename: Giulia
authors.initials: G
authors.lastname: Gagliardi
authors.affiliation: From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.).
authors.forename: Grazia Maria
authors.initials: GM
authors.lastname: Tiralongo
authors.affiliation: From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.).
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pisani
authors.affiliation: From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.).
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Novelli
authors.affiliation: From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.).
authors.forename: Barbara
authors.initials: B
authors.lastname: Vasapollo
mesh_terms: D000328:Adult; D001795:Blood Pressure Determination; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D020073:Gravidity; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D008423:Maternal Age; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000503:physiopathology*; D011247:Pregnancy; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: diastolic dysfunction; echocardiography; hemodynamics; hypertension; left ventricular remodeling; preeclampsia; pregnancy