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Abnormal Diastolic Filling Patterns Identified in Preeclampsia with Severe Features
Abstract Number: T-46
Abstract Type: Original Research
Objective: Preeclampsia (PEC) is a hyperdynamic cardiovascular state with increased systemic vascular resistance. Preliminary studies suggest that PEC is associated with diastolic dysfunction (DD) in the absence of concomitant cardiovascular comorbidities; however, this remains poorly defined. We sought to determine whether PEC with severe features (PEC-SF) is associated with unique patterns of DD utilizing echocardiography (ECHO).
Study Design: Participants were recruited from the Johns Hopkins Health System. Inclusion criteria included singleton pregnancies > 23 weeks. Diagnosis of PEC-SF was per ACOG (Hypertension in Pregnancy, 2013). Exclusion criteria: multiple gestation, known valvular malformations, previous cardiac surgery, known pulmonary hypertension, history of pulmonary embolism, or interstitial lung disease. PEC participants were subdivided in 2 groups: PEC-SF and PEC superimposed on preexisting hypertension (SI-PEC). We further subdivided the PEC group into PEC with DD and PEC without DD. ECHO was performed at time of consent for controls, and at time of PEC diagnosis for women with PEC. DD was assessed using American Society of Echocardiography guidelines by measuring the ratio of early diastolic mitral inflow velocity (E) and late diastolic velocity (A), and comparing E to tissue Doppler septal velocity of the mitral annulus (e’). Septal E/e’ ratio of >15 was defined as increased filling pressure. Statistical analyses were performed using Stata, version 14.
Results: Controls (n=36), PEC-SF (n=46), and SI-PEC (n=17) had similar demographic characteristics, except race with significantly more black participants in the preeclamptic groups when compared to controls. Mitral Septal E/e’and septal e’ were significantly different in controls when compared to PEC-SF and SI-PEC: 7.35 (1.58) vs 10.6 (2.9) vs 11.4 (2.7) for E/e’, p<0.001, respectively; and 11.6 (1.9) vs 9.8 (2.5) vs 8.9 (1.9), p < 0.001 for septal e’, respectively. 29/61 (30%) of women with PEC had echocardiographic evidence of DD. When we compared preeclamptic women with and without DD to controls, the PEC w/DD had lower mitral e’ when compared to controls and PEC w/o DD group (Table).
Conclusion: In this prospective cohort, we found increased LAA and septal E/e’ in the PEC-SF and SI-PEC group. We also found that 30% of our cohort had echocardiographic evidence of DD with significantly decreased septal e’ in the PEC w/DD group when compared to controls and PEC w/o DD. These data may help guide anti-hypertensive therapy and cardiac risk stratification after pregnancy.