Insights into cardiac alterations after pre-eclampsia: an echocardiographic study

OBJECTIVES: Pre-eclampsia (PE) is associated with persistent abnormalities in cardiac findings, known to be important in cardiovascular (CV) risk stratification. Two-dimensional (2D) speckle tracking echocardiography (STE) allows an objective quantification of myocardial deformation overcoming many of the limitations of tissue Doppler imaging (TDI), and provides insights into aspects of left ventricular (LV) function that were exclusively analyzed by magnetic resonance imaging. Early-onset (EO) and late.onset (LO) PE could be more than one disease leading to a different CV involvement, being myocardial and vascular impairment more frequent after pregnancies complicated by the early form of the disease than the late one. Understanding LV performance status requires examining not only the properties of the left ventricle itself, but also investigating the modulating effects of the arterial system on LV function. This aspect is globally resumed in the concept of ventricular-arterial coupling (VAC). The aim of this study was to investigate CV performance status few years after EOPE or LOPE taking into account myocardial 2D strain, LV torsional mechanics and VAC. METHODS: 30 non-pregnant women with a previous singleton pregnancy complicated by EOPE, 30 who experienced LOPE and 30 controls underwent echocardiography from 6 months to 4 years after delivery. All the study cohort was free from any CV risk factor. VAC was defined as the ratio between aortic elastance (Ea) and left ventricular end-systolic elastance (Ees). RESULTS: The EOPE group showed a subclinical impairment in left ventricular systole and a slight alteration in right ventricular function. Although VAC was normal in the whole study cohort, Ea and Ees were altered significantly more in the EOPE group than both LOPE and controls. All parameters we studied were independently associated with GA at the diagnosis of PE. CONCLUSIONS: Women with a history of EOPE showed a persistent subclinical contractile impairment involving the whole heart, if compared with LOPE and healthy controls. In previously pre-eclamptics VAC value was maintained in normal range, although its single components showed subclinical alterations which were more significant in EOPE than LOPE and controls.