Preeclampsia and cardiac dysfunction

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Because a history of preeclampsia significantly increases long-term risk of cardiovascular disease (CVD), the disorder may be a marker for early CVD. A systematic review published in Australasian Journal of Ultrasound in Medicine aimed to determine whether postpartum echocardiography could play a role in detection of CVD in women with a history of preeclampsia.   

Studies were included in the review if outcomes were measured by cardiac imaging, outcomes were assessed more than 12 weeks postpartum, and participants had a history of preeclampsia. A total of 308 studies were screened but only 13 were included in the final review (seven case-control and three cohort studies and an observational study, a longitudinal pilot study, and a cross-sectional study). 

Most studies reported normal left ventricular systolic function in women with a history of preeclampsia at different points during follow-up. However, left ventricular diastolic dysfunction was the major finding across six studies, even though they used different parameters for measurement. One study reported prevalence of persistent diastolic dysfunction as high as 52% at 1 year postpartum in women with a history of preeclampsia. Abnormal left ventricular geometry was also observed in seven studies, with concentric remodeling being the predominant finding. 

Only one study reported persistent right ventricular systo-diastolic dysfunction in women with a history of preterm preeclampsia, with resolution of changes more likely in term preeclampsia.

Three studies used the composite measure of Heart Failure Stage B (defined by the American Heart Association as previous myocardial infarction, LV concentric remodeling, LV hypertrophy, loss of systolic function or asymptomatic valve disease) as an outcome measure. Prevalence of HF-B varied from 23% at 4 years postpartum to 70 % in women with preterm preeclampsia at 1-year follow-up.

Two studies measured the natriuretic peptide, NT-pro-BNP, as a circulating hormonal biomarker of left ventricular dysfunction. One study found levels in women with a history of preeclampsia comparable to those in women with uncomplicated pregnancy histories (51 vs 52 ng/L) measured 9 to 16 years postpartum. The other study, however, noted elevated levels during pregnancies complicated with preeclampsia compared with uncomplicated pregnancies (477 vs 46 ng/L). 

The authors believe their review demonstrates that cardiac dysfunction associated with preeclampsia history is quantifiable and persistent, specifically in regard to increased risk of diastolic dysfunction and asymptomatic heart failure. Ob/gyns should recognize the increased risk in these patients and work with them on lifestyle modification. The authors suggested that screening these patients with transthoracic echocardiography more than 24 months postpartum could allow detection of cardiac dysfunction in the asymptomatic phase. They note that more research is necessary because since evidence for the benefit of this approach is not yet available.