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Maternal cardiac function in fetal growth restriction and preeclampsia
  1. KM Melchiorre1,2,
  2. AB Bhide1,
  3. AB Baltabaeva2,
  4. GRS Sutherland2,
  5. BT Thilaganathan1
  1. 1Fetal Medicine Unit, St George's Hospital, University of London, London, UK
  2. 2Department of Cardiology, St George's Hospital, University of London, London, UK

Abstract

Introduction Inadequate trophoblast invasion is a common aetiological factor for both preeclampsia (PE) and fetal growth restriction (FGR). Preterm PE is known to be associated with significant cardiac diastolic dysfunction and ventricular remodelling. The aim of this study was to assess cardiac function in normotensive preterm FGR and term PE.

Materials Prospective case-control study of 20 preterm normotensive FGR and 50 term PE vs matched normal pregnancies, respectively.

Methods Echocardiography and tissue Doppler imaging study.

Results Global diastolic dysfunction was observed in a significant number of preterm FGR (35%) and term PE (40%) vs control pregnancies (5%, p<0.01; 14%, p=0.007, respectively). Term PE, but not preterm FGR, was associated with significant left ventricular concentric remodelling (PE=60%, controls=20%, p=0.001). Multiple regression analysis demonstrated that diastolic dysfunction in FGR and PE was significantly correlated to uterine artery Doppler resistance indices and ventricular remodelling indices, respectively.

Conclusion The novel finding of this study is that diastolic dysfunction is prevalent in women with preterm FGR and term PE. Diastolic dysfunction in FGR is related to the uterine artery Doppler resistance indices, a proxy for the degree of poor trophoblast invasion. In contrast, diastolic dysfunction in term PE is related to heart remodelling, an initially adaptive response to hypertension. These findings may be important in understanding the pathogenesis of these conditions and have significant implications for risk stratification for cardiovascular disease in later life.

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