Left Atrial Mechanics Following Preeclamptic Pregnancy
Abstract
BACKGROUND:
Preterm preeclampsia is a pregnancy complication associated with myocardial dysfunction and premature cardiovascular disease morbidity and mortality. Left atrial (LA) strain is a noninvasive index of left ventricular end diastolic pressure and an early marker of heart failure risk. This study aimed to evaluate LA strain during the postpartum period in participants with and without preterm preeclampsia and to assess whether this varied in the presence of hypertension, cardiac dysfunction or both.
METHODS:
In this longitudinal cohort study, 321 women from 28 hospitals with preterm preeclampsia (cases) underwent cardiovascular assessment 6 months postpartum. This is a secondary analysis of the PHOEBE study (ISRCTN01879376). An uncomplicated pregnancy control group (n=30) was recruited from a single center for comparison. A full cross-sectional transthoracic echocardiogram was performed, and from these images, the myocardial strain of the left atrium, including reservoir, conduit, and contractile strain, as well as LA stiffness, were calculated.
RESULTS:
At 6 months postpartum, compared with controls, prior preeclampsia was associated with a significantly attenuated LA reservoir, conduit, and contractile strain, as well as increased LA stiffness (all P<0.001). LA strain was further reduced in preeclamptic women who had and had not developed hypertension, systolic, or diastolic dysfunction at 6 months postpartum (all P<0.05).
CONCLUSIONS:
LA mechanics were significantly attenuated at 6 months postpartum in participants with preterm preeclampsia, whether or not they remained hypertensive or had evidence of ventricular dysfunction. Further studies are needed to determine whether postnatal LA strain may identify women at greater risk for future cardiovascular disease.
Graphical Abstract
Get full access to this article
View all available purchase options and get full access to this article.
Supplemental Material
File (supplemental file.pdf)
- Download
- 159.40 KB
REFERENCES
1.
Wang YX, Arvizu M, Rich-Edwards JW, Wang L, Rosner B, Stuart JJ, Rexrode KM, Chavarro JE. Hypertensive disorders of pregnancy and subsequent risk of premature mortality. J Am Coll Cardiol. 2021;77:1302–1312. doi: 10.1016/j.jacc.2021.01.018
2.
Levine LD, Ky B, Chirinos JA, Koshinksi J, Arany Z, Riis V, Elovitz MA, Koelper N, Lewey J. Prospective evaluation of cardiovascular risk 10 years after a hypertensive disorder of pregnancy. J Am Coll Cardiol. 2022;79:2401–2411. doi: 10.1016/j.jacc.2022.03.383
3.
Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335:974. doi: 10.1136/bmj.39335.385301.BE
4.
Hauge MG, Damm P, Kofoed KF, Ersboll AS, Johansen M, Sigvardsen PE, Moller MB, Fuchs A, Kuhl JT, Nordestgaard BG, et al. Early coronary atherosclerosis in women with previous preeclampsia. J Am Coll Cardiol. 2022;79:2310–2321. doi: 10.1016/j.jacc.2022.03.381
5.
McCarthy FP, O’Driscoll JM, Seed PT, Placzek A, Gill C, Sparkes J, Poston L, Marber M, Shennan AH, Thilaganathan B, et al. Multicenter cohort study, with a nested randomized comparison, to examine the cardiovascular impact of preterm preeclampsia. Hypertension. 2021;78:1382–1394. doi: 10.1161/HYPERTENSIONAHA.121.17171
6.
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;73:e285–e350. doi: 10.1016/j.jacc.2018.11.003
7.
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, Newby LK, Pina IL, Roger VL, Shaw LJ, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. Circulation. 2011;123:1243–1262. doi: 10.1161/CIR.0b013e31820faaf8
8.
Parikh NI, Gonzalez JM, Anderson CAM, Judd SE, Rexrode KM, Hlatky MA, Gunderson EP, Stuart JJ, Vaidya D; American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and the Stroke Council; American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and the Stroke Council. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart Association. Circulation. 2021;143:e902–e916. doi: 10.1161/CIR.0000000000000961
9.
Melchiorre K, Sutherland GR, Liberati M, Thilaganathan B. Preeclampsia is associated with persistent postpartum cardiovascular impairment. Hypertension. 2011;58:709–715. doi: 10.1161/HYPERTENSIONAHA.111.176537
10.
Giorgione V, Khalil A, O’Driscoll J, Thilaganathan B. Peripartum screening for postpartum hypertension in women with hypertensive disorders of pregnancy. J Am Coll Cardiol. 2022;80:1465–1476. doi: 10.1016/j.jacc.2022.07.028
11.
Giorgione V, Ridder A, Kalafat E, Khalil A, Thilaganathan B. Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre-eclampsia: a systematic review and meta-analysis. BJOG. 2021;128:495–503. doi: 10.1111/1471-0528.16545
12.
Boardman H, Lamata P, Lazdam M, Verburg A, Siepmann T, Upton R, Bilderbeck A, Dore R, Smedley C, Kenworthy Y, et al. Variations in cardiovascular structure, function, and geometry in midlife associated with a history of hypertensive pregnancy. Hypertension. 2020;75:1542–1550. doi: 10.1161/HYPERTENSIONAHA.119.14530
13.
Dernellis JM, Stefanadis CI, Zacharoulis AA, Toutouzas PK. Left atrial mechanical adaptation to long-standing hemodynamic loads based on pressure-volume relations. Am J Cardiol. 1998;81:1138–1143. doi: 10.1016/s0002-9149(98)00134-9
14.
Todaro MC, Choudhuri I, Belohlavek M, Jahangir A, Carerj S, Oreto L, Khandheria BK. New echocardiographic techniques for evaluation of left atrial mechanics. Eur Heart J Cardiovasc Imaging. 2012;13:973–984. doi: 10.1093/ehjci/jes174
15.
Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M, Ballo P. Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr. 2011;24:898–908. doi: 10.1016/j.echo.2011.04.014
16.
Karsum EH, Andersen DM, Modin D, Biering-Sorensen SR, Mogelvang R, Jensen G, Schnohr P, Gislason G, Biering-Sorensen T. The prognostic value of left atrial dyssynchrony measured by speckle tracking echocardiography in the general population. Int J Cardiovasc Imaging. 2021;37:1679–1688. doi: 10.1007/s10554-020-02154-3
17.
Modin D, Biering-Sorensen SR, Mogelvang R, Alhakak AS, Jensen JS, Biering-Sorensen T. Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur Heart J Cardiovasc Imaging. 2019;20:804–815. doi: 10.1093/ehjci/jey181
18.
Alsharqi M, Huckstep OJ, Lapidaire W, Williamson W, Mohamed A, Tan CMJ, Kitt J, Burchert H, Telles F, Dawes H, et al. Left atrial strain predicts cardiovascular response to exercise in young adults with suboptimal blood pressure. Echocardiogr. 2021;38:1319–1326. doi: 10.1111/echo.15149
19.
Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, Zeeman GG, Brown MA. The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP. Pregnancy Hypertens. 2014;4:97–104. doi: 10.1016/j.preghy.2014.02.001
20.
NICE. Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. National Institute for Health and Care Excellence. 2010.
21.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1–39.e14. doi: 10.1016/j.echo.2014.10.003
22.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, et al; Houston, Texas; Oslo, Norway; Phoenix, Arizona; Nashville, Tennessee; Hamilton, Ontario, Canada; Uppsala, Sweden; Ghent and Liège, Belgium; Cleveland, Ohio; Novara, Italy; Rochester, Minnesota; Bucharest, Romania; and St. Louis, Missouri. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:1321–1360. doi: 10.1093/ehjci/jew082
23.
Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T, D’Hooge J, Donal E, Fraser AG, Marwick T, et al; Industry representatives. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19:591–600. doi: 10.1093/ehjci/jey042
24.
Nielsen AB, Skaarup KG, Hauser R, Johansen ND, Lassen MCH, Jensen GB, Schnohr P, Mogelvang R, Biering-Sorensen T. Normal values and reference ranges for left atrial strain by speckle-tracking echocardiography: the Copenhagen city heart study. Eur Heart J Cardiovasc Imaging. 2021;23:42–51. doi: 10.1093/ehjci/jeab201
25.
Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L, Addetia K, Caballero L, Kacharava G, Athanassopoulos GD, et al; NORRE Study. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2018;19:630–638. doi: 10.1093/ehjci/jey018
26.
Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16:1–11. doi: 10.1093/ehjci/jeu184
27.
Kurt M, Wang J, Torre-Amione G, Nagueh SF. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009;2:10–15. doi: 10.1161/CIRCIMAGING.108.813071
28.
Chen CH, Fetics B, Nevo E, Rochitte CE, Chiou KR, Ding PA, Kawaguchi M, Kass DA. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol. 2001;38:2028–2034. doi: 10.1016/s0735-1097(01)01651-5
29.
Holm H, Magnusson M, Jujic A, Bozec E, Girerd N. How to calculate ventricular-arterial coupling? Eur J Heart Fail. 2022;24:600–602. doi: 10.1002/ejhf.2456
30.
Chantler PD, Lakatta EG, Najjar SS. Arterial-ventricular coupling: mechanistic insights into cardiovascular performance at rest and during exercise. J Appl Physiol (1985). 2008;105:1342–1351. doi: 10.1152/japplphysiol.90600.2008
31.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2022;145:e895–e1032. doi: 10.1161/CIR.0000000000001063
32.
Stuart JJ, Tanz LJ, Rimm EB, Spiegelman D, Missmer SA, Mukamal KJ, Rexrode KM, Rich-Edwards JW. Cardiovascular risk factors mediate the long-term maternal risk associated with hypertensive disorders of pregnancy. J Am Coll Cardiol. 2022;79:1901–1913. doi: 10.1016/j.jacc.2022.03.335
33.
O’Driscoll JM, Giorgione V, Edwards JJ, Wiles JD, Sharma R, Thilaganathan B. Myocardial mechanics in hypertensive disorders of pregnancy: a systematic review and meta-analysis. Hypertension. 2022;79:391–398. doi: 10.1161/HYPERTENSIONAHA.121.18123
34.
Cameli M, Lisi M, Focardi M, Reccia R, Natali BM, Sparla S, Mondillo S. Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol. 2012;110:264–269. doi: 10.1016/j.amjcard.2012.03.022
35.
Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, Klein DA, Dixon D, Baldridge A, Rasmussen-Torvik LJ, et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging. 2016;9:10.1161/CIRCIMAGING.115.003754 e003754. doi: 10.1161/CIRCIMAGING.115.003754
36.
Park JH, Hwang IC, Park JJ, Park JB, Cho GY. Prognostic power of left atrial strain in patients with acute heart failure. Eur Heart J Cardiovasc Imaging. 2021;22:210–219. doi: 10.1093/ehjci/jeaa013
37.
Santos AB, Roca GQ, Claggett B, Sweitzer NK, Shah SJ, Anand IS, Fang JC, Zile MR, Pitt B, Solomon SD, et al. Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Heart Fail. 2016;9:e002763. doi: 10.1161/CIRCHEARTFAILURE.115.002763
38.
Kim D, Seo JH, Choi KH, Lee SH, Choi JO, Jeon ES, Yang JH. Prognostic implications of left atrial stiffness index in heart failure patients with preserved ejection fraction. JACC Cardiovasc Imaging. 2023;16:435–445. doi: 10.1016/j.jcmg.2022.11.002
39.
Laukkanen JA, Kurl S, Eranen J, Huttunen M, Salonen JT. Left atrium size and the risk of cardiovascular death in middle-aged men. Arch Intern Med. 2005;165:1788–1793. doi: 10.1001/archinte.165.15.1788
40.
Patel DA, Lavie CJ, Gilliland YE, Shah SB, Dinshaw HK, Milani RV. Prediction of all-cause mortality by the left atrial volume index in patients with normal left ventricular filling pressure and preserved ejection fraction. Mayo Clin Proc. 2015;90:1499–1505. doi: 10.1016/j.mayocp.2015.07.021
41.
Rossi A, Gheorghiade M, Triposkiadis F, Solomon SD, Pieske B, Butler J. Left atrium in heart failure with preserved ejection fraction: structure, function, and significance. Circ Heart Fail. 2014;7:1042–1049. doi: 10.1161/CIRCHEARTFAILURE.114.001276
42.
Scantlebury DC, Kattah AG, Weissgerber TL, Agarwal S, Mielke MM, Weaver AL, Vaughan LE, Henkin S, Zimmerman K, Miller VM, et al. Impact of a history of hypertension in pregnancy on later diagnosis of atrial fibrillation. J Am Heart Assoc. 2018;7:e007584. doi: 10.1161/JAHA.117.007584
43.
Williams D, Stout MJ, Rosenbloom JI, Olsen MA, Joynt Maddox KE, Deych E, Davila-Roman VG, Lindley KJ. Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction. J Am Coll Cardiol. 2021;78:2281–2290. doi: 10.1016/j.jacc.2021.09.1360
44.
Otani K, Tokudome T, Kamiya CA, Mao Y, Nishimura H, Hasegawa T, Arai Y, Kaneko M, Shioi G, Ishida J, et al. Deficiency of cardiac natriuretic peptide signaling promotes peripartum cardiomyopathy-like remodeling in the mouse heart. Circulation. 2020;141:571–588. doi: 10.1161/CIRCULATIONAHA.119.039761
45.
Rausch K, Shiino K, Putrino A, Lam AK, Scalia GM, Chan J. Reproducibility of global left atrial strain and strain rate between novice and expert using multi-vendor analysis software. Int J Cardiovasc Imaging. 2019;35:419–426. doi: 10.1007/s10554-018-1453-7
Information & Authors
Information
Published In
Copyright
© 2024 American Heart Association, Inc.
Versions
You are viewing the most recent version of this article.
History
Received: 12 December 2023
Accepted: 5 May 2024
Published online: 17 May 2024
Published in print: July 2024
Keywords
Subjects
Authors
Disclosures
Disclosures None.
Sources of Funding
None.
Metrics & Citations
Metrics
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
View Options
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
Purchase this article to access the full text.
eLetters(0)
eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.
Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.