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Evaluation of Right Sided Heart Pathology, Right Ventricular Systolic Pressure and Brain Natriuretic Peptide in Patients with Preeclampsia with Severe Features
Abstract Number: O2-02
Abstract Type: Original Research
Objective: Preeclampsia with severe features (PEC-SF) is associated with increased systemic vascular resistance and hyperdynamic cardiac function. With alterations in cardiac function, brain natriuretic peptide (BNP) levels could fluctuate since it is produced by the ventricles in response to stress. However, little is known about right cardiac parameters, particularly right ventricular systolic pressures (RVSP), as they relate to BNP in patients with preeclampsia (PEC). Therefore, we sought to compare right-sided cardiac parameters and BNP levels in women with PEC-SF compared to normal controls.
Study Design: Participants were recruited from the Johns Hopkins Health System. Inclusion criteria were singleton pregnancies > 23 weeks. Diagnosis of PEC-SF was per ACOG (Hypertension in Pregnancy, 2013). Exclusion criteria included multiples gestation, known valvular malformations, previous cardiac surgery, known pulmonary hypertension, history of pulmonary embolism, or interstitial lung disease. Preeclampsia (PEC ) participants were subdivided in two groups for subanalyses: PEC-SF and PEC superimposed based on preexisting hypertension (SI-PEC). Echocardiography (ECHO) was performed at time of consent for controls and time of diagnosis of PEC for cases. Statistical analyses were performed using ANOVA (Stata, version 14).
Results: We recruited 36 controls, 46 with PEC-SF, and 17 with SI-PEC. There were no differences in demographic data among groups, except race. Right ventricular systolic pressures (RVSP) was significantly higher in both PEC-SF and SI-PEC groups when compared to controls. Mitral septal E/e' were also significantly higher when compared to controls. BNP levels trended higher in PEC-SF and SI-PEC groups, but were not statistically significant.
Conclusions: There was a significant elevation in RVSP in the PEC-SF and SI-PEC group when compared to controls. We also found a significant elevation in mitral septal E/e'and e' suggestive of increased left atrial filling pressure and diastolic dysfunction more consistent with Class II pulmonary hypertension secondary to occult left-sided disease.