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Longitudinal Evaluation of Endothelial Function and Arterial Stiffness with EndoPAT: A Pilot Study Comparing Women with Early Versus Late Onset Preeclampsia
Abstract Number: S2A-6
Abstract Type: Original Research
Endothelial dysfunction (ED) and arterial stiffness (AS) appear to precede the clinical onset of preeclampsia (PE), and persistent ED is proposed as the underlying mechanism causing coronary artery disease and stroke later in life in women with a history of PE.(1)
EndoPAT is a non-invasive tool assessing ED and AS that is currently used in PE research.(2,3) Up to 50% of women with early onset PE (EOPE) had persistent ED while it was absent with late onset PE (LOPE).(3)
What remains unknown is the mechanism by which EF remains normal with LOPE and when and why ED 'normalizes' postpartum if it was abnormal during pregnancy. In addition, it is unknown why ED seems to persist beyond the postpartum period in women with EOPE. We hypothesized that the incidence of ED is greater with EOPE, and that in contrast to LOPE, features of AS are worse and persist well beyond postpartum in EOPE.
Women with PE were enrolled at the time of delivery, and categorized as having EOPE (≤34 weeks) or LOPE (> 34 weeks). EF, assessed with reactive hyperemia index (RHI) and AS, assessed by augmentation index (AI), were measured with EndoPAT once after delivery (< 72h) and again at 6 weeks postpartum. To test the hypothesis that RHI and AI would change by 6 weeks postpartum, we used paired t-test. Fisher's exact test was used to compare the proportion of ED and AS among women with EOPE versus LOPE.
In this ongoing study, 8 cases (2 EOPE & 6 LOPE) completed the 6-week test (Figure); total planned enrollment is N=20.
At initial testing (<72h), only 1 case had ED (RHI <1.67); she had LOPE and normal EF at 6 weeks.
At 6-weeks, only 1 case had both ED and AS; she had LOPE with normal initial tests.
So far, we cannot identify clear trends with 50% of cases having increases in RHI and 50% decreases (mean change -0.19, SD 0.79). Abnormal AS was present in 4 cases initially, with 3/4 returning to normal at 6 weeks.
Our initial findings support the premise that LOPE is associated with a low incidence of ED postpartum.
Abnormal AS was present in 50% of cases immediately postpartum, but seems to normalize by 6 weeks.
Additional EOPE cases are needed to further explore our hypothesis and determine whether postpartum ED that fails to normalize over time may be used as an early marker for increased risk of cardiovascular disease.
1. Circulation 2011;123:2856-69
2. Cardiovasc J Afr 2017;23;28:23-9
3. Ultrasound Obstet Gynecol 2017;49:116-23