Introduction
Pre-eclampsia (PEC) is a leading cause of maternal and perinatal morbidity and mortality worldwide affecting 1%-7% of all pregnancies[1]. PEC is defined, based on the most recent statement by the American College of Obstetricians and Gynecologists, as a systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90 mmHg measured on two occasions at least 4 h apart and proteinuria, or in the absence of proteinuria, any signs of thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms, all starting after 20 weeks of gestation[2]. The incidence of PEC has been increasing steadily in the US during the last thirty years[3] with about 50-60,000 related deaths per year worldwide[4].
Left ventricular function and the systemic circulation has been studied extensively in PEC[5, 6]. Much less attention has been paid to the pulmonary circulation and to RV function. The potential for increased pulmonary vascular resistance, elevated PA pressure and an effect on the RV in PEC is substantiated by the well-documented presence of circulating anti-angiogenic factors which are known to act on both the systemic and pulmonary vasculature [7, 8].
In this exploratory study, we hypothesize that PEC is associated with an altered echocardiographically-estimated surrogate of pulmonary artery pressure and pulmonary vascular resistance namely; pulmonary artery acceleration time. Furthermore, we hypothesize that PEC is associated with a decrement in RV function as assessed by quantifying RV MPI, RV FAC, indexed RV SV, indexed RV CO, TAPSE, TTAD and TV S’ by transthoracic echocardiography.