Cardiac magnetic resonance imaging in preeclampsia complicated by pulmonary edema shows myocardial edema with normal left ventricular systolic function - 20/07/22
, Anton F. Doubell, MBChB, MMed, HonsBSc, PhD a, Eduard J. Langenegger, MBChB, MMed, PhD b, Anna S. Herrey, FRCP, MD, PhD c, d, Lina Bergman, MD, PhD b, e, f, Karl Bergman, MD g, Catherine Cluver, MBChB, MMed, PhD b, h, Christelle Ackermann, MBChB, MMed, PhD i, Philippus G. Herbst, MBChB, FRCP, MMed aAbstract |
Background |
Preeclampsia complicates approximately 5% of all pregnancies. When pulmonary edema occurs, it accounts for 50% of preeclampsia-related mortality. Currently, there is no consensus on the degree to which left ventricular systolic dysfunction contributes to the development of pulmonary edema.
Objective |
This study aimed to use cardiac magnetic resonance imaging to detect subtle changes in left ventricular systolic function and evidence of acute left ventricular dysfunction (through tissue characterization) in women with preeclampsia complicated by pulmonary edema compared with both preeclamptic and normotensive controls.
Study Design |
Cases were postpartum women aged ≥18 years presenting with preeclampsia complicated by pulmonary edema. Of note, 2 control groups were recruited: women with preeclampsia without pulmonary edema and women with normotensive pregnancies. All women underwent echocardiography and 1.5T cardiac magnetic resonance imaging with native T1 and T2 mapping. Gadolinium contrast was administered to cases only. Because of small sample sizes, a nonparametric test (Kruskal-Wallis) with pairwise posthoc analysis using Bonferroni correction was used to compare the differences between the groups. Cardiac magnetic resonance images were interpreted by 2 independent reporters. The intraclass correlation coefficient was calculated to assess interobserver reliability.
Results |
Here, 20 women with preeclampsia complicated by pulmonary edema, 13 women with preeclampsia (5 with severe features and 8 without severe features), and 6 normotensive controls were recruited. There was no difference in the baseline characteristics between groups apart from the expected differences in blood pressure. Left atrial sizes were similar across all groups. Women with preeclampsia complicated by pulmonary edema had increased left ventricular mass (P=.01) but had normal systolic function compared with the normotensive controls. Furthermore, they had elevated native T1 values (P=.025) and a trend toward elevated T2 values (P=.07) in the absence of late gadolinium enhancement consistent with myocardial edema. Moreover, myocardial edema was present in all women with eclampsia or hemolysis, elevated liver enzymes, and low platelet count. Women with preeclampsia without severe features had similar findings to the normotensive controls. All cardiac magnetic resonance imaging measurements showed a very high level of interobserver correlation.
Conclusion |
This study focused on cardiac magnetic resonance imaging in women with preeclampsia complicated by pulmonary edema, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count. We have demonstrated normal systolic function with myocardial edema in women with preeclampsia with these severe features. These findings implicate an acute myocardial process as part of this clinical syndrome. The pathogenesis of myocardial edema and its relationship to pulmonary edema require further elucidation. With normal left atrial sizes, any hemodynamic component must be acute.
Le texte complet de cet article est disponible en PDF.Key words : cardiac magnetic resonance imaging, eclampsia, hemolysis, elevated liver enzymes, and low platelet count, preeclampsia, pulmonary edema, ventricular edema
Plan
| The authors report no conflict of interests. |
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| The cardiology research was funded by the Cardiology research fund, University of Stellenbosch, Cape Town, South Africa. Support for the Preeclampsia Obstetric Adverse Event biobank was provided by the Swedish Medical Society, the Märta Lundqvist Foundation, the Swedish Foundation for International Cooperation in Research and Higher Education, the Jane and Dan Olssons Foundation, the Mercy Perinatal, the Swedish Research Council (Vetenskapsrådet), the Center for Clinical Research Dalarna, and the Preeclampsia Foundation. The sponsors had no input into the study design; collection, analysis, and interpretation of data; writing of the report; and decision to submit the article for publication. |
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| Cite this article as: Joubert LH, Doubell AF, Langenegger EJ, et al. Cardiac magnetic resonance imaging in preeclampsia complicated by pulmonary edema shows myocardial edema with normal left ventricular systolic function. Am J Obstet Gynecol 2022;227:292.e1-11. |
Vol 227 - N° 2
P. 292.e1-292.e11 - août 2022 Retour au numéro
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