Key result
Women with a history of HELLP syndrome or pre-eclampsia had an increased myocardial performance index compared to controls (0.34 and 0.36 vs 0.26; P=0.008 and P=0.006) 13-18 years post-pregnancy.
Why the study?
Does a history of pre-eclampsia or HELLP syndrome impair cardiac function in asymptomatic women many years after pregnancy?
Case-Control (n=48)
Does a history of pre-eclampsia or HELLP syndrome impair cardiac function in asymptomatic women many years after pregnancy?
Absolute Event Rate: 0.34% vs 0.26%
p-value: p=0.008
Asymptomatic women with a history of pre-eclampsia or HELLP syndrome show subclinical impaired cardiac function (increased myocardial performance index) 13-18 years after pregnancy.
May indicate long-term subclinical cardiac impairment in asymptomatic women; hypothesis-generating for targeted surveillance after pre-eclampsia or HELLP.
OBJECTIVE: Epidemiological observations have shown that women with pre-eclampsia are at increased risk for subsequent development of cardiovascular disease. We evaluated maternal haemodynamics in asymptomatic women many years after pre-eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome. DESIGN: Case-control study. SETTING: University-based department of obstetrics. POPULATION: Forty-eight women, 13-18 years after the affected pregnancy: 17 women with a history of HELLP syndrome, 14 women with a history of pre-eclampsia and 17 women following normal pregnancy (control group). METHODS: Echocardiographic examination was performed in all groups, recording the isovolumetric contraction time and isovolumetric relaxation time (ICT + IVRT), ejection time (ET), myocardial performance index (MPI), transmitral early to atrial filling velocity ratio (MV-E/MV-A), stroke volume (SV) and cardiac output (CO). MAIN OUTCOME MEASURES: Cardiac function. RESULTS: Women with previous HELLP syndrome showed a significantly increased MPI (0.34 versus 0.26; P = 0.008) and ICT + IVRT (442.16 versus 415.03; P = 0.01); MV-E/A, SV, ET and CO were not significantly different. Women with a history of pre-eclampsia showed a significantly increased MPI (0.36 versus 0.26; P = 0.006) and decreased ET (317.3 versus 328.93; P = 0.04); ICT + IVRT, MV-E/A, SV and CO were not significantly different. CONCLUSION: This study confirms epidemiological observations that women with pre-eclampsia are at increased risk for subsequent development of cardiovascular disease. Many years after HELLP syndrome or pre-eclampsia, asymptomatic women have an increased risk for impaired cardiac function as shown by an increased MPI.
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Stróbl et al. (2010) conducted a case-control in Pre-eclampsia and HELLP syndrome (n=48). History of HELLP syndrome or pre-eclampsia vs. History of normal pregnancy was evaluated on Cardiac function (myocardial performance index) (p=0.008). Women with a history of HELLP syndrome or pre-eclampsia had an increased myocardial performance index compared to controls (0.34 and 0.36 vs 0.26; P=0.008 and P=0.006) 13-18 years post-pregnancy.
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