Low Plasma Volume and Increased Pressure Load Relate to Concentric Left Ventricular Remodeling After Preeclampsia: A Longitudinal Study
Open Access
- 6 October 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Heart Association
- Vol. 9 (19)
- https://doi.org/10.1161/jaha.119.015043
Abstract
Background During uncomplicated pregnancy, left ventricular remodeling occurs in an eccentric way. In contrast, during preeclamptic gestation, the left ventricle hypertrophies concentrically, concurrent with loss in circulatory volume and increased blood pressure. Concentric cardiac structure persists in a substantial proportion of women and may be associated with pressure and volume load after preeclampsia. We hypothesize that low volume load, as indicated by plasma volume (PV) after preeclampsia and increased pressure load, is associated with remote concentric remodeling. Methods and Results In this longitudinal cohort study, we included 100 formerly preeclamptic women. Two visits were performed: at 0.8 years postpartum and at 4.8 years postpartum. During visit 1, we measured blood pressure and PV (I125 dilution technique, low PV ≤48 mL/kg lean body mass). During the second visit, we assessed cardiac geometry by cardiac ultrasound. Concentric remodeling was defined as relative wall thickness >0.42 and left ventricular mass index ≤95 g/m2. We adjusted multivariable analysis for primiparity, systolic blood pressure, PV mL/kg lean body mass, and antihypertensive medication at visit 1. Low PV is associated with remote concentric remodeling (odds ratio [OR], 4.37; 95% CI, 1.06–17.40; and adjusted OR, 4.67; 95% CI, 1.02–21.42). Arterial pressure load (systolic, diastolic, and mean arterial pressure) is also associated with development of concentric remodeling (OR, 1.15 [95% CI, 0.99–1.35]; OR, 1.24 [95% CI, 0.98–1.58]; and OR, 1.20 [95% CI, 0.98–1.47], respectively). Conclusions In former preeclamptic women, development toward left ventricular concentric remodeling is associated with low volume load and increased pressure load.This publication has 55 references indexed in Scilit:
- Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysisEuropean Journal of Epidemiology, 2012
- Pressure OverloadHeart Failure Clinics, 2012
- Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 UpdateCirculation, 2011
- Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update: A Guideline From the American Heart AssociationJournal of the American College of Cardiology, 2011
- Review: Preeclampsia and future cardiovascular risk: formal risk factor or failed stress test?Therapeutic Advances in Cardiovascular Disease, 2008
- Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysisBMJ, 2007
- Risk Factors for Cardiovascular Disease in Women with a History of Pregnancy Complicated by Preeclampsia or Intrauterine Growth RestrictionHypertension in Pregnancy, 2007
- Low Plasma Volume Coincides With Sympathetic Hyperactivity and Reduced Baroreflex Sensitivity In Formerly Preeclamptic PatientsJournal of the Society for Gynecologic Investigation, 2006
- Venous distensibility during pregnancy. Comparisons between normal pregnancy and preeclampsia.Hypertension, 1994
- Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements.Circulation, 1978