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.