Speckle Tracking Echocardiography: New Ways of Translational Approaches in Preeclampsia to Detect Cardiovascular Dysfunction

Figures

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  Figure 1. Formerly preeclamptic women and rats from a transgenic animal model were characterized postpartum regarding cardiac alterations in function and structure. Early onset preeclamptic women showed a lower gestational age than controls but were matched on scanning time after delivery.

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  Figure 2. The transgenic rat model simulates cardiac alterations of a human preeclamptic pregnancy. Global longitudinal strain (A) and global longitudinal strain rate (B) were decreased after preeclampsia (PE). Global radial strain (C) and the corresponding strain rate (D) were not altered after PE. Global circumferential strain (E) and global circumferential strain rate (F) were reduced in the post-PE animals but not in the human cohort. Ejection fraction was reduced in animals and showed the same trend in the human PE data (G). Stroke volume (H), cardiac output (I), end-diastolic (J), and end-systolic volume (K) were not altered in either species after PE. Left ventricle (LV) posterior wall (L) and relative wall thickness (M) were increased due to PE in both species. LV mass (N) was only increased in the post-PE animals. LV end-diastolic diameter (O) was unaltered. Heart rate was higher in PE animals and showed increasing trends in humans (P). Mean values ± SEM, unpaired students t-test, ns. Non-significant, * p < 0.05, ** p < 0.01, *** p < 0.001, **** p < 0.0001.

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  Figure 3. Relative values of post-preeclamptic changes in the animal model and in the human situation. Controls of each species were normalized to one. Grey line = controls, purple line = PE human, red line = PE animal; PE preeclampsia.

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  Figure 4. Intraobserver comparison. In analyses of animal data, there was an excellent correlation between the two repeated evaluations of ejection fraction, r = 0.97, p < 0.0001 (A), and global longitudinal strain, r = 0.98, p < 0.0001 (B) within one observer. The excellent agreement between the two evaluations was substantiated in the corresponding Bland–Altman plots, which showed only a marginal bias, mean difference (95% CI for limits of agreement) 0.75 (4.50 to −3.00) for ejection fraction (C) and −0.50 (1.30 to −2.31) for global longitudinal strain (D). In human data analyses, there was likewise an excellent intraobserver correlation regarding measurements of ejection fraction, r = 0.94, p < 0.0001 (E), and global longitudinal strain, r = 0.98, p < 0.0001 (F). Only minor bias was seen in the corresponding Bland–Altman plots: 0.44 (4.48 to −3.61) for repeated evaluation of human ejection fraction (G) and −0.11 (1.36 to −1.58) for global longitudinal strain (H). EF = ejection fraction, GLS = global longitudinal strain.

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  Figure 5. Interobserver comparison. In analysis by two experts, variability comparison showed moderate to strong correlation between the assessments for animal EF (A) and GLS (B) with a moderate bias, as shown in the Bland–Altman plots, mean difference (95% CI for limits of agreement) of 1.56 (−4.96 to 8.09) for animal EF (C) and −1.01 (−9.30 to 7.28) for animal GLS (D). A moderate to strong correlation was also shown between the assessments of the two observers for human EF (E) and GLS (F) with a moderate bias, as shown in the Bland–Altman plots, mean difference of −4.50 (−12.27 to 3.27) for human EF (G) and −1.08 (−5.79 to 3.64) for human GLS (H).