Transthoracic echocardiographic assessment of haemodynamics in severe pre‐eclampsia and HIV in South Africa

Haemodynamic and cardiac structural changes in severe pre-eclampsia and in pregnant women with human immunodeficiency virus (HIV) infection have not been clearly established. We performed transthoracic echocardiography on 105 women. Women with pre-eclampsia demonstrated (mean (SD), untreated vs treated) preserved fractional shortening (40 (7.1)% vs. 41 (8.6)%), a non-dilated left ventricle (4.5 (0.49) cm vs. 4.4 (0.44) cm), increased mitral valve E/septal e' (10.5 (3.3) vs. 10.6 (2.8)), and preserved tricuspid annular plane systolic exertion (2.6 (0.36) cm vs. 2.4 (0.51) cm). Women with HIV infection demonstrated (mean (SD), HIV-positive vs healthy) a reduced cardiac index (2.8 (0.64) ml.min(-1) .m(-2) vs. 3.1 (0.7) ml.min(-1) .m(-2) , p = 0.029), reduced septal s' tissue Doppler velocity (8.5 (1.5) cm.s(-1) vs. 9.3 (1.7) cm.s(-1) , p = 0.042), increased left ventricular end-diastolic area (7.6 (2.1) cm2 vs. 6.3 (1.7) cm2 , p = 0.004), and reduced right ventricular s' and e' velocity (s' velocity 14.7 (3.1) cm.s(-1) vs. 7.0 (2.9) cm.s(-1) p = 0.001, e' velocity 16.3 (4.1) cm.s(-1) vs. 18.7 (3.4) cm.s(-1) , p = 0.013). The mitral value E/septal e' was > 8 in 39% of patients with HIV. Fractional shortening (< 28%) was reduced in 10% of healthy women, and mitral valve E/septal e' ratios were > 8 in 38% of that group. Women with pre-eclampsia demonstrated preserved systolic function, with diastolic dysfunction. Women with HIV demonstrated reduced left and right ventricular systolic function, with increased ventricular dilatation.