Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-05-18T06:19:44.964Z Has data issue: false hasContentIssue false
  • English
  • Français

MATERNAL CARDIAC TWIST PRE-PREGNANCY: POTENTIAL AS A NOVEL MARKER OF PRE-ECLAMPSIA

Published online by Cambridge University Press:  13 December 2013

VICTORIA L. MEAH ,
JOHN R. COCKCROFT  and
ERIC J. STÖHR
VICTORIA L. MEAH
Affiliation:
Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.
JOHN R. COCKCROFT
Affiliation:
Wales Heart Research Institute, Cardiff University, Cardiff, UK.
ERIC J. STÖHR*
Affiliation:
Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.
*
Dr Eric Stöhr, Cardiff School of Sport, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, CF23 6XD Cardiff, UK. Email: estohr@cardiffmet.ac.uk
Get access Rights & Permissions [Opens in a new window]

Extract

Healthy pregnancy is characterised by progressive physiological adaptation of the maternal cardiovascular (CV) system that facilitates optimal fetal development. The adaptations that constitute a healthy or normal progression are not always evident, and, in particular, CV adaptation to pregnancy is highly individualised. Some women develop pregnancy-related CV dysfunction such as pre-eclampsia (PE). Typically, PE is diagnosed by the development of hypertension and proteinuria after 20 weeks of pregnancy and is the leading cause of maternal and perinatal mortality and morbidity. Despite continued efforts to improve the understanding of the aetiology, pathophysiology and subsequently treatment for the disease, CV changes in PE are not well understood. PE before 34 weeks (early onset PE) is believed to differ in pathogenesis from late onset PE (>34 weeks) and can be characterised by a haemodynamic profile of increased systemic vascular resistance (SVR) and lower cardiac output (CO). Early onset PE is more often associated with uteroplacental insufficiency and significant adverse maternal and perinatal outcomes. In contrast, late onset PE (>34 weeks) involves an increased CO and lower SVR and is less likely to be associated with uteroplacental insufficiency and adverse perinatal outcomes. It is not known if PE develops secondary to the CV maladaptation in pregnancy or if a preexisting CV dysfunction predisposes some women to develop PE. Screening, diagnosis and disease management would be vastly improved if more were known about the onset of the maladaptive process associated with PE. To date, a combination of maternal factors including medical history, body mass index, age, parity and blood pressure (BP) have been used to predict the development of PE. In the first trimester, arterial stiffness is significantly increased in women who develop PE. Current hypotheses speculate that CV dysfunction is evident very early in pregnancy in PE and precedes the clinical manifestation at a later stage but whether CV dysfunction is present before pregnancy remains to be elucidated.

Type
Hypotheses
Information
Fetal and Maternal Medicine Review , Volume 24 , Issue 4 , November 2013 , pp. 289 - 295
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1Poon, LC, Karagiannis, G, Leal, A, Romero, XC, Nicolaides, KH. Hypertensive disorders in pregnancy: screening by uterine artery Doppler imaging and blood pressure at 11–13 weeks. Ultrasound Obstet Gynecol 2009; 34 (5): 497–502.CrossRefGoogle ScholarPubMed
2Milne, F, Redman, C, Walker, J, Baker, P, Bradley, J, Cooper, C, et al.The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community. BMJ 2005; 330 (7491): 576–80.CrossRefGoogle ScholarPubMed
3Khan, KS, Wojdyla, D, Say, L, Gulmezoglu, AM, Van Look, PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367 (9516): 1066–74.Google Scholar
4Valensise, H, Vasapollo, B, Gagliardi, G, Novelli, GP. Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease. Hypertension 2008; 52 (5): 873–80.Google Scholar
5Wen, SW, Xie, RH, Tan, H, Walker, MC, Smith, GN, Retnakaran, R. Preeclampsia and gestational diabetes mellitus: pre-conception origins? Med Hypotheses 2012; 79 (1): 120–5.Google Scholar
6Sohlberg, S, Stephansson, O, Cnattingius, S, Wikstrom, AK. Maternal body mass index, height, and risks of preeclampsia. Am J Hypertens 2012; 25 (1): 120–5.CrossRefGoogle ScholarPubMed
7Duckitt, K, Harrington, D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 2005; 330 (7491): 565.CrossRefGoogle ScholarPubMed
8Khalil, A, Akolekar, R, Syngelaki, A, Elkhouli, M, Nicolaides, KH. Maternal hemodynamics at 11–13 weeks’ gestation and risk of pre-eclampsia. Ultrasound Obstet Gynecol 2012; 40 (1): 28–34.CrossRefGoogle ScholarPubMed
9Wen, S, Tan, H, Xie, R, Smith, GN, Walker, M. A pre-conception cohort to study preeclampsia in China: rationale, study design, and preliminary results. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2012; 37 (11): 1081–7.Google Scholar
10Buckberg, GD. Basic science review: the helix and the heart. J Thorac Cardiovasc Surg 2002; 124 (5): 863–83.Google Scholar
11Dokainish, H, Sengupta, R, Pillai, M, Bobek, J, Lakkis, N. Assessment of left ventricular systolic function using echocardiography in patients with preserved ejection fraction and elevated diastolic pressures. Am J Cardiol 2008; 101 (12): 1766–71.Google Scholar
12Vendelin, M, Bovendeerd, PH, Engelbrecht, J, Arts, T. Optimizing ventricular fibers: uniform strain or stress, but not ATP consumption, leads to high efficiency. Am J Physiol Heart Circ Physiol 2002; 283 (3): H1072–81.CrossRefGoogle Scholar
13Beyar, R, Sideman, S. Left ventricular mechanics related to the local distribution of oxygen demand throughout the wall. Circ Res 1986; 58 (5): 664–77.Google Scholar
14Stöhr, EJ, McDonnell, B, Thompson, J, Stone, K, Bull, T, Houston, R, et al.Left ventricular mechanics in humans with high aerobic fitness: adaptation independent of structural remodelling, arterial haemodynamics and heart rate. J Physiol 2012; 590 (9): 2107–19.Google Scholar
15Burns, AT, La Gerche, A, Prior, DL, Macisaac, AI. Left ventricular torsion parameters are affected by acute changes in load. Echocardiography 2010; 27 (4): 407–14.Google Scholar
16Weiner, RB, Weyman, AE, Khan, AM, Reingold, JS, Chen-Tournoux, AA, Scherrer-Crosbie, M, et al.Preload dependency of left ventricular torsion: the impact of normal saline infusion. Circ Cardiovasc Imaging 2010; 3 (6): 672–8.CrossRefGoogle ScholarPubMed
17Weiner, RB, Weyman, AE, Kim, JH, Wang, TJ, Picard, MH, Baggish, AL. The impact of isometric handgrip testing on left ventricular twist mechanics. J Physiol 2012; 590 (Pt 20): 5141–50.CrossRefGoogle ScholarPubMed
18Helle-Valle, T, Crosby, J, Edvardsen, T, Lyseggen, E, Amundsen, BH, Smith, HJ, et al.New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation 2005; 112 (20): 3149–56.CrossRefGoogle ScholarPubMed
19Rademakers, FE, Buchalter, MB, Rogers, WJ, Zerhouni, EA, Weisfeldt, ML, Weiss, JL, et al.Dissociation between left ventricular untwisting and filling. Accentuation by catecholamines. Circulation 1992; 85 (4): 1572–81.Google Scholar
20Hunyor, SN. Vascular, volume, and cardiac response to normal and hypertensive pregnancy. Hypertension 1984; 6 (6 Pt 2): III129–32.Google Scholar
21Estensen, ME, Beitnes, JO, Grindheim, G, Aaberge, L, Smiseth, OA, Henriksen, T, et al.Altered maternal left ventricular contractility and function during normal pregnancy. Ultrasound Obstet Gynecol 2013; 41 (6): 659–66.CrossRefGoogle ScholarPubMed
22Yoon, AJ, Song, J, Megalla, S, Nazari, R, Akinlaja, O, Pollack, S, et al.Left ventricular torsional mechanics in uncomplicated pregnancy. Clin Cardiol 2011; 34 (9): 543–8.Google Scholar
23Savu, O, Jurcut, R, Giusca, S, van Mieghem, T, Gussi, I, Popescu, BA, et al.Morphological and functional adaptation of the maternal heart during pregnancy. Circ Cardiovasc Imaging 2012; 5 (3): 289–97.Google Scholar
24Geva, T, Mauer, MB, Striker, L, Kirshon, B, Pivarnik, JM. Effects of physiologic load of pregnancy on left ventricular contractility and remodeling. Am Heart J 1997; 133 (1): 53–9.Google Scholar
25Novelli, GP, Vasapollo, B, Gagliardi, G, Tiralongo, GM, Pisani, I, Manfellotto, D, et al.Left ventricular midwall mechanics at 24 weeks’ gestation in high-risk normotensive pregnant women: relationship to placenta-related complications of pregnancy. Ultrasound Obstet Gynecol 2012; 39 (4): 430–7.Google Scholar
26Oakley, C, Warnes, CA. Heart disease in pregnancy, 2nd ed. Oxford, UK: Blackwell; 2007.CrossRefGoogle ScholarPubMed
27Nio, AQX, Stöhr, EJ, Meah, V, Stembridge, M, Shave, R, editors. Cardiac function and left ventricular mechanics in men and women at rest and during exercise. In: European College of Sport Science 18th annual congress. Barcelona, Spain: European College of Sport Science; 2013.Google Scholar
28Clapp, JF 3rd, Capeless, E. Cardiovascular function before, during, and after the first and subsequent pregnancies. Am J Cardiol 1997; 80 (11): 1469–73.Google Scholar
29Papadopoulou, E, Kaladaridou, A, Agrios, J, Matthaiou, J, Pamboukas, C, Toumanidis, S. Factors influencing the twisting and untwisting properties of the left ventricle during normal pregnancy. Echocardiography 2013; DOI: 10.1111/echo.12345.Google Scholar
30Mahendru, AA, Everett, TR, Wilkinson, IB, Lees, CC, McEniery, CM. Maternal cardiovascular changes from pre-pregnancy to very early pregnancy. J Hypertens 2012; 30 (11): 2168–72.Google Scholar
31Gibbons, RJ, Balady, GJ, Beasley, JW, Bricker, JT, Duvernoy, WF, Froelicher, VF, et al.ACC/AHA guidelines for exercise testing. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on Exercise Testing). J Am Coll Cardiol 1997; 30 (1): 260–311.Google Scholar
32Estensen, ME, Remme, EW, Grindheim, G, Smiseth, OA, Segers, P, Henriksen, T, et al.Increased arterial stiffness in pre-eclamptic pregnancy at term and early and late postpartum: a combined echocardiographic and tonometric study. Am J Hypertens 2013; 26 (4): 549–56.Google Scholar
33Burns, AT, La Gerche, A, MacIsaac, AI, Prior, DL. Augmentation of left ventricular torsion with exercise is attenuated with age. J Am Soc Echocardiogr 2008; 21 (4): 315–20.Google Scholar