Ultrazvočna ocena hemodinamičnega stanja in srčne funkcije pri težki preeklampsijiAmbrožič, Jana (Avtor) Lučovnik, Miha (Mentor) Prokšelj, Katja (Komentor) preeclampsiaechocardiographydiastolic functionlung ultrasoundfluid responsivenessObjective. The objective of this study was to assess whether echocardiographic parameters in combination with lung ultrasound can detect dynamic changes in hemodynamic status, cardiac function and lung congestion in women with severe features of preeclampsia and healthy controls immediately before and in the first days after delivery. We hypothesized that women with severe features of preeclampsia more frequently present with impaired left ventricular diastolic function, have higher degree of lung congestion that is related to impaired diastolic function parameters and are less fluid responsive compared with healthy pregnant women. Methods. 30 severe preeclamptic women and 30 healthy term controls were evaluated within 1 day before delivery, 1 day post-delivery and 4 days post-delivery. At each examination standard two-dimensional, pulsed wave and tissue Doppler echocardiography was performed. Left ventricular myocardial deformation parameters were assessed by two-dimensional speckle tracking imaging. Lung ultrasound was performed by the 28-rib interspaces technique and Echo Comet Score (ECS) was obtained as the sum of B-lines representing the amount of extravascular lung water. Fluid responsiveness was assessed by measuring changes in left ventricular stroke volume with passive leg rising and it was defined as an increase in stroke volume of at least 12%. Results. Hemodynamic characteristics Women with severe features of preeclampsia had significantly higher arterial blood pressures (mean arterial pressure: median 110 (range 103–119) mmHg vs. 88 (81–96) mmHg, p<0.001) and peripheral vascular resistance (1694 (1480–1871) dynes×s×cm-5 vs. 1411 (1173–1612) dynes×s×cm-5, p=0.004), while heart rate (77 (70–89) bpm vs. 75 (69–84) bpm, p=0.736) and stroke volumes (70 (61–78) ml vs. 68 (57–76) ml, p=0.194) were comparable between both groups. Left ventricular systolic and diastolic function Ejection fraction was similar in both groups at all examinations (before delivery: 66 (64–71)% vs. 66 (61–67)%, p=0.061; 1 day post-delivery: 65 (62–70)% vs. 64 (62–66)%, p=0.09; 4 days post-delivery: 64 (60–71)% vs. 65 (60–69)%, p=0.592); however, peak systolic myocardial velocities (s’) at the septal and lateral mitral annulus and global longitudinal strain values (GLS) were lower in preeclamptic women 4 days post-delivery (s’ at the septal mitral annulus: 7.4 (6.6-7.8) cm/s vs. 8.1 (7.9-9.3) cm/s, p=0.001; GLS: &#8210;21.7 (&#8210;22.6 to &#8210;20.8)% vs. &#8210;23.0 (&#8210;23.9 to &#8210;21.8)%, p=0.027). At all assessments peak early diastolic myocardial velocities (e’) were significantly lower (e’ at the septal mitral annulus before delivery: 8.7 (7.0-10.3) cm/s vs. 9.0 (8.2-10.7) cm/s, p=0.062; 1 day post-delivery: 8.2 (7.2-9.6) cm/s vs. 9.8 (8.7-11.0) cm/s, p=0.001; 4 days post-delivery: 8.5 (7.7-9.6) cm/s vs. 10.3 (9.0-12.1) cm/s, p<0.001) and the ratio of the peak velocity of early diastolic mitral inflow (E) to e’ (E/e’) was significantly higher in preeclamptic women than in controls (before delivery: 8.2 (6.3-10.1) vs. 6.3 (5.3-7.7), p=0.002; 1 day post-delivery: 8.6 (7.6-10.2) vs. 6.9 (6.2-7.7), p=0.001; 4 days post-delivery: 8.3 (7.1-9.0) vs. 6.8 (5.9-7.3), p=0.003). Lung ultrasound and fluid responsiveness ECS was significantly higher in preeclamptic women than in controls before delivery (16 (9–25) vs. 6 (2–7), p<0.001) and 1 day post-delivery (15 (8–26) vs. 9 (6–14), p=0.007), but not 4 days post-delivery (7 (2–13) vs. 4 (2–8), p=0.091). Significant positive correlations between ECS and E/e’ were found before and immediately post-delivery in preeclamptic group (Spearman, before delivery: r=0.572, p=0.001; 1 day post-delivery: r=0.442, p=0.018). Fluid responsiveness was observed in significantly more controls than in women with severe features of preeclampsia (12 (43%) vs. 3 (11%), p=0.014) before delivery. Conclusions. Preeclampsia with severe features is associated with impaired diastolic function parameters that persist in the first days after delivery. Preeclamptic women have greater amount of extravascular lung water before and immediately post-delivery compared with healthy controls and lung congestion correlates with impaired parameters of diastolic function. Worsening of systolic function parameters 4 days after delivery in preeclamptic women might indicate subtle systolic dysfunction, which could become unmasked with the effect of augmented volume load related to fluid mobilization in the postpartum period. This finding seems to corroborate our results of passive leg raising test showing that the majority of preeclamptic women were fluid non-responsive and as such, could not be able to increase myocardial contraction force with fluid loading.20192019-05-22 07:15:08Doktorsko delo/naloga107745sl