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Quantification of hemodynamics and myocardial tissue characteristics in healthy pregnant women and women with preeclampsia using cardiac magnetic resonance
Abstract Number: SA-18
Abstract Type: Original Research
Introduction:Preeclampsia(PE) is a hypertensive cardiovascular(CVS) disorder & a leading cause of global maternal mortality. Women with PE have increased cardiac output, reduced diastolic function, pericardial effusions & increased left ventricular(LV) wall diameters on echocardiography(TTE). Women with PE also have higher risk of CVS complications in later life that may be related to PE induced changes within the myocardial tissue (myocardial edema or fibrosis). TTE cannot differentiate between causes of increased wall thickness & cannot characterize the myocardium therefore it is uncertain whether this finding on TTE in women with PE is true LV hypertrophy or myocardial edema & whether fibrosis is present. Furthermore some healthy pregnant women(HP), for unknown reasons, have increased LV wall diameters & altered hemodynamics. Cardiac magnetic resonance(CMR),a new non-invasive imaging technique, can assess hemodynamics & characterise myocardial tissue. There are no studies of CMR in women with PE. We aimed to determine hemodynamics & myocardial structure using CMR in healthy pregnant(HP) & PE women.
Method:After IRB approval & consent 36 women(31 HP & 5 PE) underwent CMR. HP women were ASA 1 & non-smokers. PE women had new onset hypertension & end organ dysfunction. Women with chronic hypertension, multiple pregnancy, BMI>45 kg.m-2 were excluded. CMR was performed & analysed using CMRtools(Cardiovascular Imaging Solutions,UK) for volumetric analysis, & semi-quantification of STIR (short-tau inversion recovery) images for myocardial edema assessment. Myocardial edema was assessed by measuring myocardial signal intensity & comparing to the signal intensity from skeletal muscle(serratus anterior). Signal intensities were measured from 16 LV segments (basal(6),mid-chamber(6),apical(4)) & averaged to obtain global myocardial signal intensity. Myocardial edema was defined as a myocardial:skeletal tissue intensity ratio of ≥2.0.
Results:The mean±SD age, gestation & body mass index for HP & PE women was 33±4.5 vs 36±3.4 years (p=0.22), 36±3.9 vs 33±5.0 weeks (p=0.29), 30±5.0 vs 28±2.1 kg.m-1 (p=0.15) respectively. Table shows hemodynamic & signal intensity data.
Conclusions:CMR can quantify hemodynamics & characterise myocardial tissue composition in HP women & in women with PE. Our data suggests that women with PE have a different myocardial wall composition & this may be due to edema not muscle. Further work is needed to investigate this novel finding.