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Maternal cardiac function after HELLP syndrome: an echocardiographic study.
Ultrasound in Obstetrics & Gynecology 2016 November 11
OBJECTIVES: To evaluate maternal hemodynamics in asymptomatic women with a pregnancy complicated by hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and compare it with patients with a previous preeclampsia (PE) and controls with uncomplicated pregnancies.
METHODS: Women with a history of PE (n = 60) or HELLP syndrome (n = 49) and matched healthy controls (n = 60) underwent an echocardiographic examination 6 months-4 years after delivery, recording left ventricular (LV) dimensions, ejection fraction (LVEF) and mass, right ventricular (RV) tricuspid annular plane systolic movement (TAPSE) and fractional area changing (FAC). Diastolic filling (E/A and E/E' ratios) and tissue Doppler imaging were evaluated for both ventricles and the myocardial performance index (MPI) was calculated.
RESULTS: Only women with previous HELLP syndrome showed a significant LV concentric hypertrophy (20.4%). On the contrary, LV concentric remodeling (46.9 % and 46.7%, respectively), diastolic dysfunction (expressed as altered E/A and E/E' ratios) and reduced LVEF (14.3% and 21.7%, respectively) were documented in both cases groups. RV variables did not significantly differ between cases and controls, except for FAC and E/E' which were slightly impaired in women with previous HELLP (16.3% vs 10.0%, p = 0.04; 14.3 vs 3.3%, p = 0.03; respectively).
CONCLUSIONS: The significant overlap among echocardiographic features in women with previous PE or HELLP syndrome suggests that these two conditions share in common the same pathophysiology. However, HELLP syndrome may lead to more severe cardiovascular remodelling at short-medium term after delivery.
METHODS: Women with a history of PE (n = 60) or HELLP syndrome (n = 49) and matched healthy controls (n = 60) underwent an echocardiographic examination 6 months-4 years after delivery, recording left ventricular (LV) dimensions, ejection fraction (LVEF) and mass, right ventricular (RV) tricuspid annular plane systolic movement (TAPSE) and fractional area changing (FAC). Diastolic filling (E/A and E/E' ratios) and tissue Doppler imaging were evaluated for both ventricles and the myocardial performance index (MPI) was calculated.
RESULTS: Only women with previous HELLP syndrome showed a significant LV concentric hypertrophy (20.4%). On the contrary, LV concentric remodeling (46.9 % and 46.7%, respectively), diastolic dysfunction (expressed as altered E/A and E/E' ratios) and reduced LVEF (14.3% and 21.7%, respectively) were documented in both cases groups. RV variables did not significantly differ between cases and controls, except for FAC and E/E' which were slightly impaired in women with previous HELLP (16.3% vs 10.0%, p = 0.04; 14.3 vs 3.3%, p = 0.03; respectively).
CONCLUSIONS: The significant overlap among echocardiographic features in women with previous PE or HELLP syndrome suggests that these two conditions share in common the same pathophysiology. However, HELLP syndrome may lead to more severe cardiovascular remodelling at short-medium term after delivery.
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