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Mesa A, Puig-Jové C, Pané A, Vinagre I, López-Quesada E, Meler E, Alonso-Carril N, Quirós C, Amor AJ, Perea V. Preeclampsia as an independent predictor of atherosclerosis progression in women with type 1 diabetes: a 5-year prospective study. Cardiovasc Diabetol 2025; 24:160. [PMID: 40205402 PMCID: PMC11983752 DOI: 10.1186/s12933-025-02719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Accepted: 03/29/2025] [Indexed: 04/11/2025] Open
Abstract
BACKGROUND Preeclampsia (PE) and type 1 diabetes (T1D) are significant risk factors for cardiovascular disease (CVD), but their combined effect on atherosclerosis progression has not been fully explored. This study aimed to evaluate the impact of T1D and PE on the progression of atherosclerosis. METHODS Prospective cohort study of 112 women divided into four groups: T1D + /PE + (n = 28), T1D + /PE- (n = 28), T1D-/PE + (n = 28), and T1D-/PE- (n = 28). Participants underwent an initial assessment and a follow-up visit five years later, which included anthropometric evaluation, blood tests, and carotid ultrasound. Atherosclerosis progression was defined as an increase in carotid plaque number or the occurrence of a cardiovascular event (CVE) during follow-up (fatal or non-fatal ischemic heart disease, fatal or non-fatal stroke, and/or heart failure). RESULTS A total of 104 women (92.9%) completed the follow-up (54 with T1D, mean age at inclusion 45.2 ± 7.6 years, mean follow-up 5.3 ± 1.2 years). An increase in carotid plaques was identified in 34 women (32.7%), and 3 CVEs (2.9%) occurred. In women with T1D, a history of PE was associated with a twofold increase in atherosclerosis progression (57.7% vs 25.0%, p = 0.015). In multivariate models adjusted for age, T1D and cardiovascular risk factors, PE [OR 4.97 (1.61-15.29), p = 0.005] and PE + T1D [OR 7.69 (1.25-47.29), p = 0.028] were independently associated with atherosclerosis progression. CONCLUSIONS PE was a strong independent predictor of atherosclerosis progression over a 5-year follow-up period, with an additive effect in T1D. These findings highlight preeclampsia as a significant CVD risk enhancer in young women with T1D.
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Affiliation(s)
- Alex Mesa
- Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Carlos Puig-Jové
- Endocrinology and Nutrition Department, Hospital Universitari Mútua Terrassa, Doctor Robert Sq, 08221, Terrassa, Barcelona, Spain
| | - Adriana Pané
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eva López-Quesada
- Obstetrics and Gynecology Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Eva Meler
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu., Barcelona, Spain
| | - Núria Alonso-Carril
- Endocrinology and Nutrition Department, Hospital Universitari Mútua Terrassa, Doctor Robert Sq, 08221, Terrassa, Barcelona, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua Terrassa, Doctor Robert Sq, 08221, Terrassa, Barcelona, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua Terrassa, Doctor Robert Sq, 08221, Terrassa, Barcelona, Spain.
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Zhang Y, Xue J, Li S, Yang H, Kang C. Impact of bariatric surgery on carotid intima-media thickness and arterial stiffness in metabolically healthy obesity: a prospective study. Hormones (Athens) 2024; 23:467-475. [PMID: 38819742 DOI: 10.1007/s42000-024-00568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Cardiovascular disease is one of the leading causes of mortality in patients with obesity. Metabolically healthy obesity (MHO), in which people do not have metabolic disorders, is a transient state of obesity. However, over the long term, a proportion of individuals with MHO develop metabolic syndrome (MetS). We aimed to investigate the effect of substantial weight loss following bariatric surgery in MHO on carotid intima-media thickness (CIMT) and pulse-wave velocity (PWV), which are independent predictors of subclinical atherosclerosis. METHODS This prospective study included 38 patients (34 women, four men) undergoing bariatric surgery who had severe obesity but without comorbidities (hypertension, diabetes, and hyperlipidemia), and 28 control individuals who were matched for age and sex. CIMT and PWV of the left common carotid artery were measured. At 12-month follow-up after bariatric surgery, measurements were repeated in the 38 patients with obesity. RESULTS Mean baseline body mass index (BMI) in the MHO group was 40.55 ± 3.59 kg/m2, which decreased by 33.1% after bariatric surgery. Compared with controls, CIMT and PWV were increased in MHO (543.53 ± 55.29 vs. 407.82 ± 53.09 μm, 6.70 ± 1.22 vs. 5.45 ± 0.74 m/s, respectively; all P < 0.001). At 12 months post-bariatric surgery, CIMT in MHO was lower than baseline (466.79 ± 53.74 vs. 543.53 ± 55.29 μm, P = 0.009), but PWV was not significantly different from baseline (6.27 ± 0.86 vs. 6.70 ± 1.22 m/s, P = 0.132). Multivariate regression showed that BMI was an independent predictor of CIMT (β = 0.531, P < 0.001). CONCLUSION Carotid artery structure and function were impaired in MHO, and improved carotid artery structure was associated with weight loss in MHO after bariatric surgery.
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Affiliation(s)
- Yanxia Zhang
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 99 Longcheng Street, Taiyuan City, Shanxi Province, 030032, China
| | - Jiping Xue
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 99 Longcheng Street, Taiyuan City, Shanxi Province, 030032, China
| | - Shuai Li
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 99 Longcheng Street, Taiyuan City, Shanxi Province, 030032, China
| | - Hongyu Yang
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 99 Longcheng Street, Taiyuan City, Shanxi Province, 030032, China
| | - Chunsong Kang
- Department of Ultrasonography, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 99 Longcheng Street, Taiyuan City, Shanxi Province, 030032, China.
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Gabel AM, Cheu L, Pike M, Olerich KL, Kachikis A, McCartney SA, Shree R. Elevated Cardiovascular Biomarkers Following Hypertensive Disorder of Pregnancy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.06.24311582. [PMID: 39211847 PMCID: PMC11361229 DOI: 10.1101/2024.08.06.24311582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Hypertensive disorder of pregnancy (HDP) is associated with an increased risk for later-life cardiovascular disease (CVD). Whether the HDP pregnancy itself confers risk towards CVD later in life is suggested in several epidemiologic studies. Given this connection and that the HDP exposure itself may play a role, understanding whether markers associated with cardiovascular risk vary based on HDP history in the years following pregnancy may assist with risk stratification and development of targeted interventions. We measured 77 proteins (CVD-associated and inflammatory markers) in n=22 individuals with a history of HDP and n=43 matched controls with no HDP history at a median of 4 years after pregnancy. Several CVD-associated proteins (fibrinogen, fetuin-A, L-selectin, and alpha-1-acid glycoprotein) were significantly elevated, by orders of magnitude, in individuals with a history of HDP compared to normotensive pregnancies (all p<0.0001). In multivariable linear regression models controlling for age, body mass index, chronic hypertension, and diabetes, a history of HDP remained associated with higher levels of CVD-associated proteins (all p<0.0001). We clustered samples based on global patterns of CVD protein expression and found a significant difference in CVD protein expression patterns between post-Normal and post-HDP samples. Conversely, differences in circulating inflammatory markers were largely insignificant or more subtle than that observed with the CVD-associated proteins. Identification of biomarkers associated with CVD in the intervening years after HDP but before evident CVD is critical to understanding post-HDP cardiovascular risk to provide insight for the development of therapeutic interventions that mitigate CVD event risk in this high-risk population.
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Heidema WH, Van Drongelen J, Spaanderman MEA, Scholten RR. Impact of body mass index on markers of vascular health in normotensive women with history of pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:122-129. [PMID: 36807940 DOI: 10.1002/uog.26182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/23/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Obesity and pre-eclampsia (PE) are both associated with vascular dysfunction, which translates into an increased risk for cardiovascular disease in later life. The aim of this study was to investigate whether there is an interaction between body mass index (BMI) and a history of PE in their effects on vascular health. METHODS This was an observational case-control study of 30 women with a history of PE who were compared with 31 age- and BMI-matched controls who had an uncomplicated pregnancy. Flow-mediated dilation (FMD), carotid intima-media thickness (cIMT) and carotid distensibility (CD) were measured 6-12 months postpartum. To evaluate the impact of physical fitness, maximum oxygen uptake capacity was assessed using a standardized maximum exhaustion cycling test using breath-by-breath analysis. To specify further BMI subgroups, metabolic syndrome constituents were assessed in all individuals. RESULTS Formerly pre-eclamptic women had significantly lower FMD (5.1 ± 2.1% vs 9.4 ± 3.4%; P < 0.01), higher cIMT (0.59 ± 0.09 vs 0.49 ± 0.07 µm; P < 0.01) and lower CD (1.54 ± 0.37%/10 mmHg vs 1.80 ± 0.39%/10 mmHg; P < 0.01) compared with controls. In our study, population BMI correlated negatively with FMD (P = 0.04) but not with cIMT or CD. BMI and PE did not exhibit an interaction effect on these vascular parameters. Physical fitness was lower in women with a history of PE and in women with higher BMI. Constituents of the metabolic syndrome, including insulin, homeostasis model assessment for insulin resistance (HOMA-ir), triglyceride, microalbuminuria and systolic and diastolic blood pressure, were significantly higher in formerly pre-eclamptic women. BMI affected glucose metabolism but not lipids or blood pressure. BMI and PE positively interacted in their effect on insulin (P = 0.04) and HOMA-ir (P = 0.02). CONCLUSIONS Both BMI and a history of PE have negative effects on endothelial function, insulin resistance and physical fitness. In formerly pre-eclamptic women, the effect of BMI on insulin resistance was particularly high, suggesting a synergistic effect. Additionally, independently of BMI, a history of PE was associated with reduced FMD and CD and increased cIMT and blood pressure. Recognizing the cardiovascular risk profile is important for informing patients and encouraging targeted lifestyle modifications. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W H Heidema
- Maternal and Fetal Medicine, Radboud University Medical Centre Nijmegen/Amalia Children's Hospital, Nijmegen, The Netherlands
| | - J Van Drongelen
- Maternal and Fetal Medicine, Radboud University Medical Centre Nijmegen/Amalia Children's Hospital, Nijmegen, The Netherlands
| | - M E A Spaanderman
- Maternal and Fetal Medicine, Radboud University Medical Centre Nijmegen/Amalia Children's Hospital, Nijmegen, The Netherlands
| | - R R Scholten
- Maternal and Fetal Medicine, Radboud University Medical Centre Nijmegen/Amalia Children's Hospital, Nijmegen, The Netherlands
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Pikir BS, Subagjo A, Wardhani DE, Andrianto, Oktaviono YH, Nugraha RA. Comparison of carotid intima media thickness between women with history of preeclampsia and normal pregnancy: a meta-analysis of systematic review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
On a clinical level, preeclampsia and atherosclerotic cardiovascular disease share common risk factors. Carotid intima media thickness (CIMT) is ultrasound-based imaging, non-invasive, simple, and reproducible method of subclinical atherosclerosis evaluation. Nowadays, there were studies concerning of CIMT among preeclamptic women, although the results were different.
Objective
To prove that CIMT among women with histories of preeclampsia was greater compared to normal pregnancy.
Methods
We conducted a meta-analysis of studies that reported CIMT, in women who had preeclampsia and had normal pregnancy. Studies were identified through three databases: PubMed, Google Scholar, and SAGE Journals with publication year of 2010–2020. Heterogeneity was assessed using the I2 statistic. Standardized mean difference was used as measured of effect size.
Results
Nine eligible studies were included in the meta-analysis. This meta-analysis consisted of 439 women with preeclampsia histories and 526 women with normal pregnancy histories. Women who had preeclampsia had significantly higher CIMT compared to those with normal pregnancy with standardized mean difference −0.38 and 95% confidence interval (CI) −0.68 to −0.07 (p=0.02).
Conclusion
CIMT was greater among women with histories of preeclampsia compared to normal pregnancy.
Trial registration
PROSPERO CRD42021228825
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Abdull Sukor AN, Ankasha SJ, Ugusman A, Aminuddin A, Mokhtar NM, Zainal Abidin S, Ahmad MF, Hamid A. Impact of offspring endothelial function from de novo hypertensive disorders during pregnancy: An evidence-based review. Front Surg 2022; 9:967785. [PMID: 36420416 PMCID: PMC9676434 DOI: 10.3389/fsurg.2022.967785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/29/2022] [Indexed: 09/08/2024] Open
Abstract
De novo hypertensive disorders of pregnancy (HDP) which consist of gestational hypertension and preeclampsia affect maternal and offspring morbidity and mortality, and potentially increase the risk of cardiovascular disease in the offspring. It is well known that de novo HDP causes various maternal complications, including cardiovascular diseases, placental abruption and liver and kidney failure. However, there are studies suggesting that offspring of pregnancies complicated by de novo HDP have an increased risk of long-term cardiovascular disease. The endothelium is an important regulator of vascular function, and its dysfunction is highly associated with the development of cardiovascular diseases. Hence, this review aimed to systematically identify articles related to the effect of de novo HDP on the endothelial function of the offspring. A computerized database search was conducted on PubMed, Scopus, and Medline from 1976 until 2022. A total of 685 articles were obtained. We identified another three additional articles through review articles and Google Scholar. Altogether, we used 13 articles for data extraction. All studies reported that endothelial function was impaired in the offspring of de novo HDP. This is most likely attributed to impaired vasodilation, subclinical atherosclerosis formation, inflammation, and dysregulated epigenetic regulation of endothelial functions.
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Affiliation(s)
| | - Sheril June Ankasha
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Amilia Aminuddin
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norfilza Mohd Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shahidee Zainal Abidin
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Kuala Nerus, Malaysia
| | - Mohd Faizal Ahmad
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adila A. Hamid
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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7
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Increased Intima-Media Thickness of Carotid and Femoral Arteries in Women with Early Preeclampsia. IRANIAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.5812/iranjradiol-121573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Preeclampsia can increase the risk of cardiovascular diseases (CVDs) later in life. Also, increased intima-media thickness (IMT) of the carotid artery was introduced as an independent risk factor for CVDs. Objectives: This study aimed to evaluate and compare the IMT of carotid and femoral arteries between women with early preeclampsia and normotensive pregnant and nulligravid women. Methods: In this study, which was conducted between May 2019 and January 2020, three groups of women were evaluated: early-onset preeclamptic pregnant women, normotensive pregnant women, and nulligravid women. The IMTs of the common femoral artery, superficial femoral artery, common carotid artery, carotid bulb, and internal carotid artery were measured using B-mode ultrasound. Results: A total of 100 women were enrolled in each group. The means ± SD of age in preeclamptic, normotensive and nulligravid women were 27.78 ± 3.23, 27.16 ± 3.09, and 27.11 ± 2.95, respectively. The mean gestational age of the two pregnant groups was nearly 32 weeks. Based on the results, the mean systolic blood pressure, diastolic blood pressure, and arterial pressure were significantly higher in the preeclamptic group compared to the other groups (P < 0.001). The mean IMT of both sides of the common carotid artery, carotid bulb, internal carotid artery, common femoral artery, and superficial femoral artery was significantly higher in the preeclamptic group compared to normotensive pregnant and nulligravid women (P < 0.001). Conclusion: Preeclampsia was associated with the increased IMT of common and internal carotid arteries, as well as common and superficial femoral arteries. Therefore, IMT measurements in preeclamptic women can provide an opportunity to identify those who may benefit from early screening and preventive care to reduce the risk of CVDs in the future.
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Cipolla MJ, Tremble S, DeLance N, Allison D, Johnson AC. Treatment with apocynin selectively restores hippocampal arteriole function and seizure-induced hyperemia in a model of preeclampsia. J Cereb Blood Flow Metab 2022; 42:1425-1436. [PMID: 35137612 PMCID: PMC9274854 DOI: 10.1177/0271678x221080092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/06/2022] [Accepted: 01/21/2022] [Indexed: 12/31/2022]
Abstract
Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with neurovascular dysfunction, cognitive impairment and increased seizure susceptibility. Here, we sought to determine if treatment of experimental PE (ePE) rats with apocynin could prevent hippocampal arteriolar (HA) dysfunction and impaired seizure-induced hyperemia within the hippocampus, a brain region central to cognition and seizure generation. Isolated and pressurized HAs from Sprague Dawley rats that were normal pregnant (Preg; n = 8), ePE (n = 8) or ePE treated with apocynin for 2 weeks of gestation (ePE + apo; n = 8) were compared. Hippocampal blood flow (n = 6/group) was measured using hydrogen clearance before and during seizure. Aorta elastin was quantified using histochemistry. ePE was associated with HA dysfunction including reduced contraction to endothelin-1 and diminished dilation to the endothelium-dependent vasodilator NS309 that was prevented by apocynin. However, apocynin had no effect on ePE-induced impairment of dilation to the nitric oxide donor sodium nitroprusside, but increased myogenic tone and substantially increased HA distensibility. Seizure-induced hyperemia was impaired in ePE rats that was restored by apocynin. Aorta from ePE rats had reduced elastin content, suggesting large artery stiffness, that was unaffected by apocynin. Thus, while apocynin partially prevented HA dysfunction, its restoration of functional hyperemia may be protective of seizure-induced injury during eclampsia.
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Affiliation(s)
- Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
- Department of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Sarah Tremble
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Nicole DeLance
- Department of Pathology, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Dana Allison
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Abbie C Johnson
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
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Barr LC, Herr JE, Hétu MF, Smith GN, Johri AM. Increased carotid artery stiffness after preeclampsia in a cross-sectional study of postpartum women. Physiol Rep 2022; 10:e15276. [PMID: 35439370 PMCID: PMC9017974 DOI: 10.14814/phy2.15276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
Preeclampsia (PE) is a hypertensive obstetrical complication associated with increased cardiovascular disease risk. Carotid artery functional assessments allow for identification of subclinical vascular dysfunction. This cross‐sectional study measured carotid artery functional indices in healthy women with a recent pregnancy complicated by PE, versus women with a prior uncomplicated pregnancy. Women with a history of PE (N = 30) or an uncomplicated pregnancy (N = 30), were recruited between 6 months and 5 years postpartum. Left and right carotid artery ultrasound measured carotid intima media thickness, plaque burden, peak systolic velocity, end diastolic flow velocity and carotid far‐wall circumferential strain (FWCS). Carotid FWCS is inversely related to vessel stiffness, where a decrease in FWCS indicates increased vessel stiffness. Right‐side FWCS did not differ between women with a history of PE versus normotensive pregnancy. Left carotid artery FWCS was lower in formerly preeclamptic women after adjustment for diameter, pulse pressure, and heart rate compared to women following an uncomplicated pregnancy (3.35 ± 1.08 × 10−3 vs. 4.46 ± 1.40 × 10−3; p = 0.003). Those with prior severe PE had the greatest decrease in FWCS adjusted to diameter, pulse pressure, and heart rate compared to healthy controls (p = 0.02). Adjusted FWCS and total serum cholesterol were independent indicators of PE history when present in a logistic regression model with confounding variables including age, body mass index, and resting blood pressure. Further investigation is needed to elucidate if FWCS can be used as a risk stratification tool for future cardiovascular disease following a pregnancy complicated by PE. A history of PE is associated with decreased left FWCS (increased left carotid artery stiffness).
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Affiliation(s)
- Logan C Barr
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Julia E Herr
- Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Marie-France Hétu
- Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics & Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Amer M Johri
- Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Pitz Jacobsen D, Fjeldstad HE, Johnsen GM, Fosheim IK, Moe K, Alnæs-Katjavivi P, Dechend R, Sugulle M, Staff AC. Acute Atherosis Lesions at the Fetal-Maternal Border: Current Knowledge and Implications for Maternal Cardiovascular Health. Front Immunol 2021; 12:791606. [PMID: 34970270 PMCID: PMC8712939 DOI: 10.3389/fimmu.2021.791606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022] Open
Abstract
Decidua basalis, the endometrium of pregnancy, is an important interface between maternal and fetal tissues, made up of both maternal and fetal cells. Acute atherosis is a uteroplacental spiral artery lesion. These patchy arterial wall lesions containing foam cells are predominantly found in the decidua basalis, at the tips of the maternal arteries, where they feed into the placental intervillous space. Acute atherosis is prevalent in preeclampsia and other obstetric syndromes such as fetal growth restriction. Causal factors and effects of acute atherosis remain uncertain. This is in part because decidua basalis is challenging to sample systematically and in large amounts following delivery. We summarize our decidua basalis vacuum suction method, which facilitates tissue-based studies of acute atherosis. We also describe our evidence-based research definition of acute atherosis. Here, we comprehensively review the existing literature on acute atherosis, its underlying mechanisms and possible short- and long-term effects. We propose that multiple pathways leading to decidual vascular inflammation may promote acute atherosis formation, with or without poor spiral artery remodeling and/or preeclampsia. These include maternal alloreactivity, ischemia-reperfusion injury, preexisting systemic inflammation, and microbial infection. The concept of acute atherosis as an inflammatory lesion is not novel. The lesions themselves have an inflammatory phenotype and resemble other arterial lesions of more extensively studied etiology. We discuss findings of concurrently dysregulated proteins involved in immune regulation and cardiovascular function in women with acute atherosis. We also propose a novel hypothesis linking cellular fetal microchimerism, which is prevalent in women with preeclampsia, with acute atherosis in pregnancy and future cardiovascular and neurovascular disease. Finally, women with a history of preeclampsia have an increased risk of premature cardiovascular disease. We review whether presence of acute atherosis may identify women at especially high risk for premature cardiovascular disease.
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Affiliation(s)
| | - Heidi Elisabeth Fjeldstad
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Guro Mørk Johnsen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Ingrid Knutsdotter Fosheim
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kjartan Moe
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynaecology, Bærum Hospital, Vestre Viken HF, Bærum, Norway
| | | | - Ralf Dechend
- Experimental and Clinical Research Center, A Cooperation of Charité-Universitätsmedizin Berlin and Max-Delbruck Center for Molecular Medicine, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS-Klinikum, Berlin, Germany
| | - Meryam Sugulle
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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11
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Amor AJ, Vinagre I, Valverde M, Alonso N, Urquizu X, Meler E, López E, Giménez M, Codina L, Conget I, Barahona MJ, Perea V. Novel glycoproteins identify preclinical atherosclerosis among women with previous preeclampsia regardless of type 1 diabetes status. Nutr Metab Cardiovasc Dis 2021; 31:3407-3414. [PMID: 34663538 DOI: 10.1016/j.numecd.2021.08.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/23/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Information regarding inflammation and cardiovascular disease (CVD) risk in type 1 diabetes (T1D) or preeclampsia (PE) is scarce. We assessed differences in inflammation markers according to the presence of both conditions and their association with atherosclerosis. METHODS AND RESULTS We recruited 112 women without CVD and last pregnancy ≥5 years previously (n = 28 per group): a)T1D and PE; b)T1D without PE; c)PE without T1D; and d)Controls (without T1D or PE). Groups were matched by several CVD risk factors, and diabetes duration and retinopathy in T1D. Carotid intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) were assessed by ultrasonography. Inflammatory markers included classical variables (leucocytes and high-sensitivity C-reactive protein [hsCRP]) and glycoproteins by nuclear magnetic resonance (1H-NMR) spectroscopy (GlycA, GlycB, GlycF and the height/width [H/W] ratios of GlycA and GlycB). The age of the participants was 44.9 ± 7.8 years, and 20.5% harbored plaque. There were no differences in inflammatory markers among the four study groups. Overall, in multivariate-adjusted models, all 1H-NMR-glycoproteins (except GlycB) were positively associated with IMT measures (IMT of bulb and maximum-IMT of any carotid segment; p < 0.05). After dividing the sample according to PE status, previous findings remained largely unchanged. Furthermore, GlycF was independently associated with carotid plaque only in PE group (OR 5.08 [1.03-25.01] per 0.1 log-increments, p = 0.046). Neither leucocytes nor hsCRP were related to atherosclerosis. Regarding T1D status, non-uniform results were observed. CONCLUSIONS High 1H-NMR-glycoprotein concentrations have a negative impact on carotid atherosclerosis among women with preeclampsia, regardless of T1D status.
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Affiliation(s)
- Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain.
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Nuria Alonso
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Eva Meler
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Laura Codina
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria J Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain.
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12
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Defective Uteroplacental Vascular Remodeling in Preeclampsia: Key Molecular Factors Leading to Long Term Cardiovascular Disease. Int J Mol Sci 2021; 22:ijms222011202. [PMID: 34681861 PMCID: PMC8539609 DOI: 10.3390/ijms222011202] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 12/12/2022] Open
Abstract
Preeclampsia is a complex hypertensive disorder in pregnancy which can be lethal and is responsible for more than 70,000 maternal deaths worldwide every year. Besides the higher risk of unfavorable obstetric outcomes in women with preeclampsia, another crucial aspect that needs to be considered is the association between preeclampsia and the postpartum cardiovascular health of the mother. Currently, preeclampsia is classified as one of the major risk factors of cardiovascular disease (CVD) in women, which doubles the risk of venous thromboembolic events, stroke, and ischemic heart disease. In order to comprehend the pathophysiology behind the linkage between preeclampsia and the development of postpartum CVD, a thorough understanding of the abnormal uteroplacental vascular remodeling in preeclampsia is essential. Therefore, this review aims to summarize the current knowledge of the defective process of spiral artery remodeling in preeclampsia and how the resulting placental damage leads to excessive angiogenic imbalance and systemic inflammation in long term CVD. Key molecular factors in the pathway-including novel findings of microRNAs-will be discussed with suggestions of future management strategies of preventing CVD in women with a history of preeclampsia.
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13
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Pereira MM, Torrado J, Sosa C, Zócalo Y, Bia D. Role of arterial impairment in preeclampsia: should the paradigm shift? Am J Physiol Heart Circ Physiol 2021; 320:H2011-H2030. [PMID: 33797272 DOI: 10.1152/ajpheart.01005.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Preeclampsia is a worldwide pregnancy complication with serious short- and long-term maternal and neonatal consequences. Our understanding of preeclampsia pathophysiology has significantly evolved over the last decades with the recognition that impaired arterial function and structure may occur early in the course of pregnancy, preceding the clinic-humoral syndrome and driving long-term cardiovascular disease risk in the future of these patients. Although an early abnormal placentation may be the inciting event for a large proportion of cases, there is growing evidence that challenges the placental hypothesis in all affected women, since placental histopathology lesions thought to be characteristic are neither sensitive nor specific markers for the disorder. Recent hemodynamic investigations and studies on left ventricular function and structure in women with preeclampsia further challenge this universal paradigm and propose that placental dysfunction could be secondary to a maternal cardiovascular maladaptation to pregnancy in certain patients. Supporting this hypothesis, certain vascular features, which are characteristically enhanced in normal pregnancy allowing a healthy vascular adaptation, are absent in preeclampsia and comparable to the nonpregnant population. However, arterial biomechanics in preeclampsia may only not cope with hemodynamic demands of pregnancy but also impose additional detrimental loads to the maternal heart ("impaired left-ventricle-aorta coupling") and transmit pressure and flow disturbances into the fetoplacental circulation ("impaired large arteries-microcirculation coupling"). In this review, we analyze the major role of the arterial dysfunction in the cardiovascular maladaptation hypothesis of preeclampsia, shed light on its potential etiopathogenic link, and discuss the complementary nature of the placental and cardiovascular theories.
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Affiliation(s)
- María M Pereira
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia
| | - Juan Torrado
- Jacobi Medical Center, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Claudio Sosa
- Department of Obstetrics and Gynecology "C", Pereira-Rossell Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Yanina Zócalo
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
| | - Daniel Bia
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
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14
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Neto RM, Ramos JGL, Medjedovic E, Begic E. Increased of the carotid intima media thickness in preeclampsia. J Perinat Med 2020; 48:787-791. [PMID: 32877365 DOI: 10.1515/jpm-2020-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023]
Abstract
Objectives The aim of the study was to determine carotid intima-media thickness (CIMT) values in patients who developed and did not develop preeclampsia (PE), and to determine whether CIMT values could be predictors of PE development. Methods The study included pregnant women who were examined by regular ultrasound examination at the Materno-Infantil Presidente Vargas Hospital (HMIPV) in Porto Alegre, Brazil, from April 2016 to September 2017. The examinations were performed every three months. Patients were divided into two groups. The first group included patients diagnosed with PE (n=21) and second group included patients who did not have PE (n=199). A high frequency ultrasound device (12 MHz) with a semi-automatic method was used to estimate CIMT. Results CIMT was significantly higher in pregnant women with PE than in women without PE (55±0.11 vs. 0.44±0.06, respectively; p<0.001). Using a cut-off value of 0.51 mm, CIMT had a specificity of 77.9% and sensitivity of 81% in the diagnosis of PE. With CIMT ≥0.6 mm, the probability of a patient developing PE was 44.4%; with CIMT >0.42 mm, the probability was only 4.2%. Conclusions An increase in CIMT was associated with the onset of PE. CIMT values were significantly higher in patients who develop PE.
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Affiliation(s)
- Raul Moreira Neto
- Department of Gynecology and Obstetrics, School of Medicine, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Jose Geraldo Lopes Ramos
- Department of Gynecology and Obstetrics, School of Medicine, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Department of Gynecology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Edin Begic
- Department of Pharmacology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina.,Department of Cardiology, General Hospital «Prim.dr. Abdulah Nakas», Sarajevo, Bosnia and Herzegovina
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15
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Sonaglioni A, Esposito V, Caruso C, Nicolosi GL, Bianchi S, Lombardo M, Gensini GF, Ambrosio G. Association between neutrophil to lymphocyte ratio and carotid artery wall thickness in healthy pregnant women. Eur J Obstet Gynecol Reprod Biol 2020; 255:98-104. [PMID: 33113405 DOI: 10.1016/j.ejogrb.2020.10.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Pregnancy may elicit a state of mild inflammation that might affect, either directly or indirectly, haematological parameters associated with systemic inflammation. In particular, both Neutrophil-to-lymphocyte ratio (NLR) and Red blood cells Distribution Width (RDW) have been found to be elevated in complicated pregnancy. However, data regarding the association of these haematological parameters with common carotid artery (CCA) intima-media thickness (IMT) in healthy pregnancy are scanty. Aim of this study was to evaluate possible changes in CCA-IMT during normal pregnancy and in the postpartum period, and to correlate these changes with NLR and RDW. STUDY DESIGN Between October 2019 and February 2020, a prospective study was carried out on 73 consecutive healthy pregnant women (32.8 ± 4.9 yrs/old). Women underwent obstetric assessment, complete blood cell counts with calculation of NLR and RDW, two-dimensional transthoracic echocardiography and carotid Doppler ultrasonography. RESULTS During normal pregnancy, both NLR and RDW progressively increased (p < 0.0001); likewise, parameters of carotid dimensions also significantly increased (p < 0.0001). Hematological and morphological changes all decreased in postpartum period. By univariable logistic regression, the variables which showed the greatest independent association with CCA-IMT (defined as CCA-IMT ≥0.55 mm) were: age (HR 1.33, 95% CI 1.15-1.53, p < 0.0001), pre-pregnant BMI (HR 2.75, 95% CI 1.72-4.41, p < 0.0001), third trimester E/e' ratio (HR 1.64, 95% CI 1.34-2.02, p < 0.0001), and third trimester NLR (HR 3.00, 95% CI 1.64-5.50, p < 0.0001). Multivariable logistic regression analysis demonstrated that third trimester NLR was the only variable that retained statistical significance (HR 2.49, 95% CI 1.35-4.59, p = 0.003). An NLR ≥ 2 reached 83% of sensitivity and 99% of specificity in identifying a CCA-IMT ≥0.55 mm (AUC = 0.95). A strong linear correlation of both third trimester NLR and RDW with CCA-IMT was observed (r = 0.89 and 0.83, respectively). CONCLUSIONS Pregnancy is a state of chronic mild inflammation and the progressive increase in NLR and RDW during normal pregnancy is significantly associated with CCA intimal-medial thickening.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy.
| | - Valentina Esposito
- Department of Gynecology and Obstetrics, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Chiara Caruso
- Department of Gynecology and Obstetrics, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Gian Luigi Nicolosi
- Department of Cardiology, Policlinico San Giorgio, Via Agostino Gemelli 10, 33170, Pordenone, Italy
| | - Stefano Bianchi
- Department of Gynecology and Obstetrics, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Gian Franco Gensini
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy
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16
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Pruijssen JT, de Korte CL, Voss I, Hansen HHG. Vascular Shear Wave Elastography in Atherosclerotic Arteries: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2145-2163. [PMID: 32620385 DOI: 10.1016/j.ultrasmedbio.2020.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
Ischemic stroke is a leading cause of death and disability worldwide, so adequate prevention strategies are crucial. However, current stroke risk stratification is based on epidemiologic studies and is still suboptimal for individual patients. The aim of this systematic review was to provide a literature overview on the feasibility and diagnostic value of vascular shear wave elastography (SWE) using ultrasound (US) in (mimicked) human and non-human arteries affected by different stages of atherosclerotic diseases or diseases related to atherosclerosis. An online search was conducted on Pubmed, Embase, Web of Science and IEEE databases to identify studies using US SWE for the assessment of vascular elasticity. A quality assessment was performed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) checklist, and relevant data were extracted. A total of 19 studies were included: 10 with human patients and 9 with non-human subjects (i.e., [excised] animal arteries and polyvinyl alcohol phantoms). All studies revealed the feasibility of using US SWE to assess individually stiffness of the arterial wall and plaques. Quantitative elasticity values were highly variable between studies. However, within studies, SWE could detect statistically significant elasticity differences in patient/subject characteristics and could distinguish different plaque types with good reproducibility. US SWE, with its unique ability to assess the elasticity of the vessel wall and plaque throughout the cardiac cycle, might be a good candidate to improve stroke risk stratification. However, more clinical studies have to be performed to assess this technique's exact clinical value.
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Affiliation(s)
- Judith T Pruijssen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Chris L de Korte
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Physics of Fluid Group, MESA+ Institute for Nanotechnology, and MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Iona Voss
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hendrik H G Hansen
- Medical Ultrasound Imaging Centre (MUSIC), Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Moe K, Sugulle M, Dechend R, Angel K, Staff AC. Functional and structural vascular biomarkers in women 1 year after a hypertensive disorder of pregnancy. Pregnancy Hypertens 2020; 21:23-29. [DOI: 10.1016/j.preghy.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
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18
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Wave intensity analysis of maternal arterial stiffness: augmentation index and pulse wave velocity in pregnancies complicated by diabetes or hypertension. Arch Gynecol Obstet 2020; 301:1199-1205. [PMID: 32303887 DOI: 10.1007/s00404-020-05517-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of our study was to compare the maternal arterial stiffness in pregnant women with diabetic disease, hypertension and those with normal pregnancies. METHODS A cross-sectional study was performed involving 65 pregnant women with diabetic disease (DD group), 26 pregnant women with hypertension (RR group) and 448 women with normal pregnancies (control group). The augmentation index (AIx) and the pulse wave velocity (PWV) of the right carotid artery were assessed using non-invasive sonographic wave intensity analysis. Furthermore, the reliability of the measurements was evaluated in 21 healthy women. RESULTS Compared with the controls, the AIx and PWV were increased in the DD group [11.0 (interquartile range, IQR 7.3, 15.2) vs. 5.7 (IQR 2.4, 9.3), P < 0.001; 5.7 (IQR 5.1, 6.4) vs. 5.2 (IQR 4.6, 6.1), P = 0.001; respectively] and the RR group [9.3 (IQR 6.6, 11.5) vs. 5.7 (IQR 2.4, 9.3), P < 0.001; 7.1 (6.3, 7.9) vs. 5.2 (IQR 4.6, 6.1), P < 0.001; respectively]. The intraclass and interclass correlation coefficients were good to excellent for the AIx (ICC: 0.91, P < 0.001 and 0.74, P < 0.002; respectively) and PWV measurements (ICC: 0.71, P < 0.004 and 0.70, P < 0.005; respectively). CONCLUSION Pregnancies complicated by diabetic disease or hypertension are associated with increased maternal arterial stiffness. The importance of wave intensity analysis needs to be verified and larger studies are needed to establish both normal and cutoff values that may be relevant for clinical decisions.
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19
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Amor AJ, Vinagre I, Valverde M, Pané A, Urquizu X, Meler E, López E, Quirós C, Giménez M, Codina L, Conget I, Barahona MJ, Perea V. Preeclampsia Is Associated With Increased Preclinical Carotid Atherosclerosis in Women With Type 1 Diabetes. J Clin Endocrinol Metab 2020; 105:dgz031. [PMID: 31529047 DOI: 10.1210/clinem/dgz031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/30/2019] [Accepted: 09/09/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Although preeclampsia (PE) is a well-established cardiovascular risk factor (CVRF) in the general population, its role in type 1 diabetes (T1D) has been scarcely studied. We assessed the association between PE and preclinical atherosclerosis in T1D. METHODS We recruited 112 women without cardiovascular disease and last pregnancy ≥5 years before: (1) T1D and previous PE (T1D+/PE+; n = 28); (2) T1D without preeclampsia (T1D+/PE-; n = 28); (3) previous PE without T1D (T1D-/PE+; n = 28); and (4) controls (without T1D or PE; T1D-/PE-; n = 28). Groups were matched by age, several CVRFs, and diabetes duration and retinopathy (in T1D participants). Carotid intima-media thickness (IMT) and the presence of plaque (IMT ≥ 1.5 mm) were assessed by standardized ultrasonography protocol. RESULTS Mean age of the participants was 44.9 ± 7.8 years (14.3% hypertension and 21.4% active smokers). Groups including T1D (T1D+/PE+ and T1D+/PE-) more frequently presented hypertension and statin treatment (23.2% vs 5.4% and 37.5% vs 8.9%; respectively; P < 0.01), without differences in other CVRFs. Carotid plaques were observed in 20.5%. In multivariate models adjusted for age, CVRF, and statins, both T1D and PE showed a similar impact on the presence of plaque, with odds ratios (95% confidence interval), 5.45 (1.36-21.9) and 4.24 (1.04-17.3), respectively. Both entities showed an additive effect when combined, both in common carotid-IMT (T1D+/PE- or T1D-/PE+, β = 0.198; T1D+/PE+, β = 0.297) and in the presence of plaque (8.53 [1.07-68.2] and 28.1 [2.67-296.4], respectively). CONCLUSIONS Previous PE was independently associated with preclinical atherosclerosis in T1D. Further studies are needed to ascertain its usefulness for stratifying risk in T1D women.
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Affiliation(s)
- Antonio J Amor
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - Irene Vinagre
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Adriana Pané
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Eva Meler
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona 08036, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Marga Giménez
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - Laura Codina
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Ignacio Conget
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - Maria J Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
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20
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Kirollos S, Skilton M, Patel S, Arnott C. A Systematic Review of Vascular Structure and Function in Pre-eclampsia: Non-invasive Assessment and Mechanistic Links. Front Cardiovasc Med 2019. [PMID: 31803759 DOI: 10.3389/fcvm.2019.00166, 10.3389/fmed.2019.00166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Hypertensive disorders of pregnancy, such as pre-eclampsia, are known to be independently associated with the development of premature cardiovascular disease (CVD) in women. In pre-eclampsia, the placenta secretes excess anti-angiogenic factors into the maternal circulation, leading to widespread endothelial damage, and inflammation. This endothelial damage is evidenced to persist beyond the acute illness. However, whether it is permanent and responsible for the elevated rates of premature CVD seen in this at-risk group remains unclear. A systematic review of the available literature with respect to vascular structure and function prior to, during and after a pregnancy complicated by pre-eclampsia was performed. Studies non-invasively assessing vascular structure using carotid intima-media thickness (CIMT), retinal microvasculature caliber, CT coronary angiogram, or coronary calcium scores were included. Vascular function was assessed using brachial flow-mediated dilation (FMD), pulse wave analysis (PWA), and peripheral arterial tonometry (PAT). In total 59 articles were included (13 CIMT, 5 CTCA/Ca score, five retinal microvasculature, 27 FMD, 7 PAT, and 14 PWV/PWA), consisting of prospective and retrospective cohort, and case-control studies. Change in vascular structure was evidenced with significant increases in CIMT by 73-180 μm greater than that of non-affected women. This is tempered by other studies reporting resolution of structural changes postpartum, highlighting the need for further research. Accelerated coronary calcification and plaque deposition was identified, with greater rates of increased calcium scores and subclinical coronary artery disease shown by CTCA in women with a history of pre-eclampsia at 30 years postpartum. Impaired endothelial function was consistently reported prior to, during and immediately after pregnancy as evidenced by differences in FMD of 1.7-12.2% less than non-affected women, an increase in PWV by 13.2-26%, and reduced retinal microvascular caliber and arterial elasticity indices. The evidence was less conclusive for the persistence of long-term endothelial dysfunction. Understanding the underlying mechanistic links between pre-eclampsia and CVD is a key step to identifying targeted therapies aimed at "repairing the endothelium" and attenuating risk. This review has highlighted the need for a greater understanding of vascular structure and function following pre-eclampsia through high quality studies with large sample sizes, particularly in the longer postpartum period when clinical CVD disease starts to manifest.
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Affiliation(s)
- Shady Kirollos
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael Skilton
- Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Sanjay Patel
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Coronary Diseases, The Heart Research Institute, Sydney, NSW, Australia
| | - Clare Arnott
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Coronary Diseases, The Heart Research Institute, Sydney, NSW, Australia.,Department of Cardiology, The George Institute for Global Health, Sydney, NSW, Australia
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21
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Kirollos S, Skilton M, Patel S, Arnott C. A Systematic Review of Vascular Structure and Function in Pre-eclampsia: Non-invasive Assessment and Mechanistic Links. Front Cardiovasc Med 2019; 6:166. [PMID: 31803759 PMCID: PMC6873347 DOI: 10.3389/fcvm.2019.00166] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022] Open
Abstract
Hypertensive disorders of pregnancy, such as pre-eclampsia, are known to be independently associated with the development of premature cardiovascular disease (CVD) in women. In pre-eclampsia, the placenta secretes excess anti-angiogenic factors into the maternal circulation, leading to widespread endothelial damage, and inflammation. This endothelial damage is evidenced to persist beyond the acute illness. However, whether it is permanent and responsible for the elevated rates of premature CVD seen in this at-risk group remains unclear. A systematic review of the available literature with respect to vascular structure and function prior to, during and after a pregnancy complicated by pre-eclampsia was performed. Studies non-invasively assessing vascular structure using carotid intima-media thickness (CIMT), retinal microvasculature caliber, CT coronary angiogram, or coronary calcium scores were included. Vascular function was assessed using brachial flow-mediated dilation (FMD), pulse wave analysis (PWA), and peripheral arterial tonometry (PAT). In total 59 articles were included (13 CIMT, 5 CTCA/Ca score, five retinal microvasculature, 27 FMD, 7 PAT, and 14 PWV/PWA), consisting of prospective and retrospective cohort, and case-control studies. Change in vascular structure was evidenced with significant increases in CIMT by 73–180 μm greater than that of non-affected women. This is tempered by other studies reporting resolution of structural changes postpartum, highlighting the need for further research. Accelerated coronary calcification and plaque deposition was identified, with greater rates of increased calcium scores and subclinical coronary artery disease shown by CTCA in women with a history of pre-eclampsia at 30 years postpartum. Impaired endothelial function was consistently reported prior to, during and immediately after pregnancy as evidenced by differences in FMD of 1.7–12.2% less than non-affected women, an increase in PWV by 13.2–26%, and reduced retinal microvascular caliber and arterial elasticity indices. The evidence was less conclusive for the persistence of long-term endothelial dysfunction. Understanding the underlying mechanistic links between pre-eclampsia and CVD is a key step to identifying targeted therapies aimed at “repairing the endothelium” and attenuating risk. This review has highlighted the need for a greater understanding of vascular structure and function following pre-eclampsia through high quality studies with large sample sizes, particularly in the longer postpartum period when clinical CVD disease starts to manifest.
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Affiliation(s)
- Shady Kirollos
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael Skilton
- Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Sanjay Patel
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Coronary Diseases, The Heart Research Institute, Sydney, NSW, Australia
| | - Clare Arnott
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Coronary Diseases, The Heart Research Institute, Sydney, NSW, Australia.,Department of Cardiology, The George Institute for Global Health, Sydney, NSW, Australia
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22
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Santhirakumaran S, Tay J, Lees C. The relationship between maternal characteristics and carotid intima-media thickness using an automated ultrasound technique. Hypertens Pregnancy 2019; 38:252-259. [PMID: 31535936 DOI: 10.1080/10641955.2019.1667382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To investigate CIMT and its relationship with maternal demographic characteristics in healthy pregnancy. Methods: CIMT was measured using an au. Results: CIMT showed no relationship with gestational age (rho=-0.124, p=0.335), parity (Z=-0.055, p=0.960) and MAP (rho=0.110, p=0.393). A relationship was found between CIMT and maternal age (rho=0.277, p=0.028), booking BMI (rho=0.278, p=0.027), and BMI at time of study (rho=0.287, p=0.023). CIMT ranged from 0.30-0.80mm, the 97.5th percentile was 0.63 mm. Conclusion: In healthy pregnancy, we reported CIMT was related to BMI and maternal age but not parity or gestational age.
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Affiliation(s)
| | - Jasmine Tay
- Imperial College School of Medicine, Imperial College London , London , UK.,Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust , London , UK
| | - Christoph Lees
- Imperial College School of Medicine, Imperial College London , London , UK.,Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust , London , UK
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23
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Benschop L, Schalekamp-Timmermans S, Schelling SJC, Steegers EAP, Roeters van Lennep JE. Early Pregnancy Cardiovascular Health and Subclinical Atherosclerosis. J Am Heart Assoc 2019; 8:e011394. [PMID: 31331213 PMCID: PMC6761659 DOI: 10.1161/jaha.118.011394] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Assessing and optimizing cardiovascular health (CVH) early in life, such as in pregnancy, could lead to a longer lifetime spent in better CVH and reduce the risk of cardiovascular disease. This might especially benefit women with a hypertensive disorder of pregnancy (HDP) who are more likely to develop atherosclerosis and cardiovascular disease. We hypothesized that CVH in pregnancy is related to later life CVH and carotid intima-media thickness (CIMT), and that these associations differ between women with a normotensive pregnancy and women with an HDP. Methods and Results This study was conducted within the prospective population-based Generation R Study. CVH in pregnancy was based on 5 metrics (blood pressure, total-cholesterol, glucose, smoking, and body mass index). Postpartum CVH additionally included physical activity and diet scores, according to the American Heart Association classification. Postpartum CVH and CIMT were measured 10 years after pregnancy. Results were analyzed for women with a normotensive pregnancy and those with an HDP. Women with a normotensive pregnancy (n=1786) and women with an HDP (n=138) were evaluated from early pregnancy until 10 years postpartum. Better CVH in early pregnancy was associated with a smaller CIMT and better postpartum CVH in all women, especially in those with an HDP (CIMT: -9.82 μm [95% CI: -17.98, -1.67]). Conclusions Already in pregnancy, better CVH is associated with a smaller CIMT and better CVH 10 years postpartum, especially in women with an HDP. As pregnancy is an incentive for women to improve lifestyle, assessing CVH in pregnancy might help improve postpartum CVH and reduce cardiovascular disease risk.
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Affiliation(s)
- Laura Benschop
- Department of Obstetrics and Gynecology Erasmus Medical Center Rotterdam the Netherlands.,Department of Epidemiology Erasmus Medical Center Rotterdam the Netherlands
| | | | - Sara J C Schelling
- Department of Obstetrics and Gynecology Erasmus Medical Center Rotterdam the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology Erasmus Medical Center Rotterdam the Netherlands
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24
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Sub-clinical atherosclerosis in the common carotid artery in women with/without previous pre-eclampsia: A seven-year follow-up. Atherosclerosis 2019; 290:206-213. [PMID: 31200939 DOI: 10.1016/j.atherosclerosis.2019.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/04/2019] [Accepted: 05/24/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Pre-eclampsia is associated with increased risk of cardiovascular disease and premature death. However, conventional common carotid artery intima-media thickness (CCA-IMT) measurement does not reflect this. In contrast, measurement of the individual CCA intima and media thicknesses clearly indicates increased vascular risk both at diagnosis and about one year after pre-eclampsia. This study examined whether individual CCA wall layers, risk factors for cardiovascular disease, and markers of endothelial dysfunction had normalized or remained unfavorable seven years after pre-eclampsia. METHODS The individual CCA intima and media thicknesses were measured using 22 MHz ultrasound. Conventional cardiovascular risk factors were recorded. A thick intima, thin media and high intima/media thickness ratio (I/M) are signs of sub-clinical atherosclerosis. RESULTS The median age of women with previous pre-eclampsia (cases = 23) or normal pregnancies (controls = 35) was 39/37 years. At follow-up (median about seven years), the intima remained thicker and the I/M was higher in cases than in controls [all p < 0.0001; p < 0.001 after adjustment for time to follow-up, body mass index (BMI), and mean arterial pressure (MAP)], whereas the CCA-IMT was illogically thinner. Further, BMI, MAP, hip circumference, abdominal height, serum endostatin and apolipoprotein B levels were higher in cases (all p < 0.05). Intima and I/M measurements were correlated with age, MAP, endostatin and apolipoprotein B, whereas no logical correlations were found for CCA-IMT. CONCLUSIONS The arteries in cases but not controls were still adversely affected after seven years. Measuring intima thickness and I/M appears preferable to measuring CCA-IMT for demonstrating vascular risk after pre-eclampsia.
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25
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Li J, Wang B, Cai A, Yuan Q, Ding H, Zhao D. Carotid arterial wall stiffness correlates positively with impedance of the umbilical and uterine arteries in women with preeclampsia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:27-35. [PMID: 30318601 DOI: 10.1002/jcu.22648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/30/2018] [Accepted: 09/14/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE This study aimed to determine whether the stiffness of the arterial walls of women with preeclampsia (PE) differs from that of healthy controls and to evaluate its association with fetal and uterine artery Doppler variables and perinatal outcomes in PE. METHODS We enrolled 30 women with PE and 30 normotensive pregnant women. Carotid artery stiffness and Doppler variables of the uterine, umbilical, and fetal middle cerebral arteries and the ductus venosus were measured in both groups. Measurements of the common carotid artery were performed by the Aloka ultrasonic echo-tracking technique. RESULTS Stiffness of the carotid artery wall of women with PE was significantly higher than that of healthy controls. It was positively correlated with the pulsatility index of the uterine and umbilical arteries and negatively correlated with the cerebroplacental ratio in women with PE. In women with PE, the carotid artery augmentation index showed negative correlations with birth weight and Apgar score. CONCLUSIONS The stiffness of the carotid arteries of women with PE is increased, and this increase is positively correlated with the impedance of the umbilical and uterine arteries.
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Affiliation(s)
- Jingyu Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bin Wang
- Department of the Third Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ailu Cai
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qian Yuan
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hao Ding
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dan Zhao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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26
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Cipolla MJ, Liebeskind DS, Chan SL. The importance of comorbidities in ischemic stroke: Impact of hypertension on the cerebral circulation. J Cereb Blood Flow Metab 2018; 38:2129-2149. [PMID: 30198826 PMCID: PMC6282213 DOI: 10.1177/0271678x18800589] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comorbidities are a hallmark of stroke that both increase the incidence of stroke and worsen outcome. Hypertension is prevalent in the stroke population and the most important modifiable risk factor for stroke. Hypertensive disorders promote stroke through increased shear stress, endothelial dysfunction, and large artery stiffness that transmits pulsatile flow to the cerebral microcirculation. Hypertension also promotes cerebral small vessel disease through several mechanisms, including hypoperfusion, diminished autoregulatory capacity and localized increase in blood-brain barrier permeability. Preeclampsia, a hypertensive disorder of pregnancy, also increases the risk of stroke 4-5-fold compared to normal pregnancy that predisposes women to early-onset cognitive impairment. In this review, we highlight how comorbidities and concomitant disorders are not only risk factors for ischemic stroke, but alter the response to acute ischemia. We focus on hypertension as a comorbidity and its effects on the cerebral circulation that alters the pathophysiology of ischemic stroke and should be considered in guiding future therapeutic strategies.
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Affiliation(s)
- Marilyn J Cipolla
- 1 Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - David S Liebeskind
- 2 Neurovascular Imaging Research Core and Stroke Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Siu-Lung Chan
- 1 Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
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27
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Memari B, Moghiseh N, Mohammadian F, Ghajarzadeh M, Ghoreishian H. Association of Pre-Eclampsia with Carotid Artery Intima⁻Media Thickness and Non-Alcoholic Fatty Liver Disease. J Clin Med 2018; 7:E275. [PMID: 30213117 PMCID: PMC6162828 DOI: 10.3390/jcm7090275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 12/28/2022] Open
Abstract
Atherosclerosis and non-alcoholic fatty liver disease (NAFLD) are considered important complications of pre-eclampsia. This study was conducted to determine the association of pre-eclampsia with non-alcoholic fatty liver disease and the association of pre-eclampsia with bilateral intima⁻media thickness (IMT; right and left), separately. Twenty-one pregnant women with pre-eclampsia and 21 normal pregnant women were enrolled in the present study. The right and left intima⁻media thicknesses of carotid arteries were evaluated using Doppler sonography. The diagnosis of NAFLD was based on sonography. Linear and binary logistic regression analyses were performed to evaluate the association between pre-eclampsia and related outcomes. The mean right IMT was determined as 0.60 ± 0.07 mm in women with pre-eclampsia and 0.51 ± 0.08 mm in normal pregnant women (p = 0.001). On the other hand, the mean left IMT was 0.59 ± 0.09 mm in women with pre-eclampsia and 0.50 ± 0.10 mm in normal pregnant women (p = 0.003). The frequencies of NAFLD in women with pre-eclampsia and normal pregnant women were found to be 66.7% and 23.8% respectively (p = 0.006). Multivariate linear regression analysis revealed an association between pre-eclampsia and right (p = 0.014) and left (p = 0.019) IMT, without removing the effects of other confounding variables. Binary regression analysis (multivariate) did not confirm an independent association between pre-eclampsia and NAFLD. Pre-eclampsia exhibited a direct and independent association with right and left IMT. Although the prevalence of NAFLD was significantly higher in women with pre-eclampsia, pre-eclampsia was not an independent predictor for NAFLD.
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Affiliation(s)
- Behzad Memari
- Department of Radiology, Zanjan University of Medical Science, Zanjan 1467933811, Iran.
| | - Niloofar Moghiseh
- Department of Radiology, Zanjan University of Medical Science, Zanjan 1467933811, Iran.
| | - Farnaz Mohammadian
- Department of Obstetrics and Gynecology, Zanjan University of Medical Science, Zanjan 1467933811, Iran.
| | - Mahsa Ghajarzadeh
- Department of Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran 1467933811, Iran.
| | - Hadi Ghoreishian
- Department of Radiology, Zanjan University of Medical Science, Zanjan 1467933811, Iran.
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28
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Antza C, Cifkova R, Kotsis V. Hypertensive complications of pregnancy: A clinical overview. Metabolism 2018; 86:102-111. [PMID: 29169855 DOI: 10.1016/j.metabol.2017.11.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 12/22/2022]
Abstract
Hypertensive disorders in pregnancy are a worldwide health problem for women and their infants complicating up to 10% of pregnancies and associated with increased maternal and neonatal morbidity and mortality. In Europe, 2.3-3% of pregnancies are complicated by preeclampsia. Gestational diabetes, obesity, no previous or multiple births, maternal age less than 20 or greater than 35years old and thrombophilia can be some of the possible factors related to increased risk for hypertension in pregnancy. Complications of hypertension during pregnancy affect both mothers and their infants. Ambulatory blood pressure monitoring helps to distinguish true hypertension from the white coat as pregnant women with office abnormal values may have normal out of office blood pressure. Imbalance between proangiogenic and antiangiogenic factors in placenta may lead to endothelial dysfunction, vasoconstriction, activation of the coagulation system, and hemolysis. Carotid intima-media thickness, pulse wave velocity, augmentation index, and arterial wall tension were found to be significantly increased in women with preeclampsia compared to normotensive pregnant women. Uterine artery Doppler and serum biomarkers can be used to evaluate the probability of hypertension and complications during pregnancy, but further research in the field is needed. Lately, micro ribonucleic acids have also been the focus of research as potential biomarkers.
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Affiliation(s)
- C Antza
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
| | - R Cifkova
- Charles University in Prague, Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic
| | - V Kotsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece.
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29
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Stanhewicz AE. Residual vascular dysfunction in women with a history of preeclampsia. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1062-R1071. [PMID: 30133302 DOI: 10.1152/ajpregu.00204.2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy characterized by new-onset hypertension, proteinuria, and edema occurring after 20 wk of gestation, with a prevalence of ~7-10% of pregnancies in the United States and ~8 million pregnancies worldwide. Despite the postpartum remission of preeclamptic symptoms, women who have had preeclampsia are two to four times more likely to develop cardiovascular disease (CVD) and are significantly more likely to die of CVD compared with women with a history of normal pregnancy. Although the relation between history of preeclampsia and elevated CVD risk is well documented, the mechanism(s) underlying this association remains unclear. One hypothesis explaining this association is that the initial vascular damage and dysfunction sustained during the preeclamptic pregnancy persist chronically. Indeed, even in the absence of, or in advance of, overt CVD women who have had preeclampsia have compromised vascular endothelial function. Emerging mechanistic studies in these women have provided some insight into the underlying mechanisms of this persistent vascular dysfunction and have begun to identify potential therapeutic targets for the prevention or mitigation of CVD progression in this vulnerable population. This review summarizes the existing literature examining vascular function and dysfunction in women with a history of preeclampsia and highlights future directions for mechanistic investigations and development of novel intervention strategies aimed at halting or slowing the progression of CVD in these women.
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Affiliation(s)
- Anna E Stanhewicz
- Department of Kinesiology, Pennsylvania State University , University Park, Pennsylvania
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30
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Namugowa A, Iputo J, Wandabwa J, Meeme A, Buga GAB, Abura S, Stofile YY. Arterial stiffness in women previously with preeclampsia from a semi-rural region of South Africa. Clin Exp Hypertens 2018; 41:36-43. [PMID: 29473758 DOI: 10.1080/10641963.2018.1441858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Women with pre-eclampsia have an increased risk of cardiovascular disease later in life. The aim of the study was to establish the presence and pattern of arterial stiffness in women previously with pre-eclampsia from a semi-rural region of South Africa. This was a prospective longitudinal study which involved 36 previously pre-eclamptic women and 86 non-pregnant controls (NPC) who had a past history of non-complicated pregnancy. Maternal wave reflection (augmentation index) and carotid-femoral pulse wave velocity were assessed noninvasively, using applanation tonometry with the SphygmoCor device. Endothelial function was assessed by EndoPAT 2000 device; pneumatic probes were fitted to the index fingers; induced flow-mediated reactive hyperemia; the ratio of the readings before and after occlusion was then used to calculate the score, the reactive hyperemia index (RHI) as a measure of endothelial function. Pulse wave velocity remained significantly higher in previously pre-eclamptic women than non-pregnant controls up to three months after delivery (p < 0.05), then it reduced to nonsignificant values. All blood pressure indices (central and brachial pressures), were higher in previously pre-eclamptic women as compared to nonpregnant controls up to one year postpartum. Regional (aortic) arterial stiffness, though it persists for some time after delivery, is transitory in previously pre-eclamptic women from the rural Africa setting. However, their increase blood pressure is an indication of compromised arterial compliance in women previously with pre-eclampsia.
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Affiliation(s)
- A Namugowa
- a Department of Human Biology, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - J Iputo
- a Department of Human Biology, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - J Wandabwa
- c Faculty of Health Sciences , Busitema University , Mbale , Uganda
| | - A Meeme
- b Departments of Obstetrics and Gynaecology and, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - G A B Buga
- b Departments of Obstetrics and Gynaecology and, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - S Abura
- a Department of Human Biology, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - Y Y Stofile
- a Department of Human Biology, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
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Abstract
Pregnancy is known to induce rapid, progressive, and substantial changes to the cardiovascular system, ultimately facilitating successful pregnancy outcomes. Women who develop hypertensive disorders during pregnancy are considered to have "failed" the cardiovascular stress test of pregnancy and likely represent a subpopulation with inadequate cardiovascular accommodation. Preeclampsia is a serious complication with a myriad of manifestations in both mother and offspring. This pregnancy syndrome is a polygenic disease and has now been linked to a greater incidence of cardiovascular disease. Moreover, offsprings born to preeclamptic mothers exhibit an elevated risk of cardiovascular disease, stroke, and mental disorders during adulthood. This suggests that preeclampsia not only exposes the mother and the fetus to complications during pregnancy but also programs chronic diseases during adulthood in the offspring. The etiology of preeclampsia remains unknown, with various theories being suggested to explain its origin. It is primarily thought to be associated with poor placentation and entails excessive maternal inflammation and endothelial dysfunction. It is well established now that the maternal immune system and the placenta are involved in a highly choreographed cross talk that underlies adequate spiral artery remodeling required for uteroplacental perfusion and free flow of nutrients to the fetus. Although it is not clear whether immunological alterations occur early during pregnancy, studies have proposed that dysregulated systemic and placental immunity contribute to impaired angiogenesis and the onset of preeclampsia. Recently emerged strong evidence suggests a potential link among epigenetics, microRNAs (miRNAs), and pregnancy complications. This chapter will focus on important aspects of epigenetics, immunological aspects, and cardiovascular and vascular remodeling of preeclampsia.
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32
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Patel AK, Suri HS, Singh J, Kumar D, Shafique S, Nicolaides A, Jain SK, Saba L, Gupta A, Laird JR, Giannopoulos A, Suri JS. A Review on Atherosclerotic Biology, Wall Stiffness, Physics of Elasticity, and Its Ultrasound-Based Measurement. Curr Atheroscler Rep 2017; 18:83. [PMID: 27830569 DOI: 10.1007/s11883-016-0635-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Functional and structural changes in the common carotid artery are biomarkers for cardiovascular risk. Current methods for measuring functional changes include pulse wave velocity, compliance, distensibility, strain, stress, stiffness, and elasticity derived from arterial waveforms. The review is focused on the ultrasound-based carotid artery elasticity and stiffness measurements covering the physics of elasticity and linking it to biological evolution of arterial stiffness. The paper also presents evolution of plaque with a focus on the pathophysiologic cascade leading to arterial hardening. Using the concept of strain, and image-based elasticity, the paper then reviews the lumen diameter and carotid intima-media thickness measurements in combined temporal and spatial domains. Finally, the review presents the factors which influence the understanding of atherosclerotic disease formation and cardiovascular risk including arterial stiffness, tissue morphological characteristics, and image-based elasticity measurement.
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Affiliation(s)
- Anoop K Patel
- Department of Computer Engineering, NIT, Kurukshetra, India
| | | | - Jaskaran Singh
- Department of Computer Engineering, NIT, Kurukshetra, India
| | - Dinesh Kumar
- Point-of-Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA
| | | | | | - Sanjay K Jain
- Department of Computer Engineering, NIT, Kurukshetra, India
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Ajay Gupta
- Radiology Department, Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - John R Laird
- UC Davis Vascular Center, University of California, Davis, CA, USA
| | | | - Jasjit S Suri
- Vascular Diagnostic Center, University of Cyprus, Nicosia, Cyprus. .,Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA. .,Department of Electrical Engineering, University of Idaho (Affl.), Moscow, ID, USA. .,Diagnosis and Stroke Monitoring Division, AtheroPoint™, Roseville, CA, USA.
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33
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The influence of prenatal exercise and pre-eclampsia on maternal vascular function. Clin Sci (Lond) 2017; 131:2223-2240. [PMID: 28798074 DOI: 10.1042/cs20171036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 01/10/2023]
Abstract
During healthy pregnancy, the cardiovascular system undergoes diverse adaptations to support adequate transfer of oxygen and nutrients from mother to fetus. In order to accommodate the large expansion of blood volume and associated cardiac output, the structure, mechanics, and function of the arteries are altered. Specifically, in healthy pregnancy there is a remodeling of arteries (increased angiogenesis and vasodilation), a generalized reduction in arterial stiffness (increased compliance), and an enhanced endothelial function. The development of pregnancy complications, specifically pre-eclampsia, is associated with poor placentation (decreased angiogenesis), increased arterial stiffness, and vascular dysfunction (reduced endothelial function). Many of the positive adaptations that occur in healthy pregnancy are enhanced in response to chronic exercise. Specifically, placental angiogenesis and endothelial function have been shown to improve to a greater extent in women who are active during their pregnancy compared with those who are not. Prenatal exercise may be important in helping to reduce the risk of vascular dysfunction in pregnancy. However, our knowledge of the vascular adaptations resulting from maternal exercise is limited. This review highlights maternal vascular adaptations occurring during healthy pregnancy, and contrasts the vascular maladaptation associated with pre-eclampsia. Finally, we discuss the role of prenatal exercise on vascular function in the potential prevention of vascular complications associated with pre-eclampsia.
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Milic NM, Milin-Lazovic J, Weissgerber TL, Trajkovic G, White WM, Garovic VD. Preclinical atherosclerosis at the time of pre-eclamptic pregnancy and up to 10 years postpartum: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:110-115. [PMID: 27859887 PMCID: PMC5310936 DOI: 10.1002/uog.17367] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/29/2016] [Accepted: 11/14/2016] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Pre-eclampsia (PE) is a pregnancy-specific hypertensive disorder that has been associated with cardiovascular risk factors and vascular changes, such as acute atherosis in placental blood vessels, similar to early-stage atherosclerosis. The objective of this study was to determine whether women with PE have increased atherosclerotic burden, as determined by the carotid intima-media thickness (CIMT), compared with women without PE. METHODS We conducted a systematic review and meta-analysis of studies that reported CIMT, a non-invasive, ultrasound-based measure of subclinical atherosclerosis, in women who did vs those who did not have PE. Studies were eligible if they had been conducted during pregnancy or during the first decade postpartum, and if CIMT was measured in the common carotid artery. Studies published before 7 March 2016 were identified through PubMed, EMBASE and Web of Science. Two reviewers used predefined forms and protocols to evaluate independently the eligibility of studies based on titles and abstracts and to perform full-text screening, data abstraction and quality assessment. Heterogeneity was assessed using the I2 statistic. Standardized mean difference (SMD) was used as a measure of effect size. RESULTS Fourteen studies were included in the meta-analysis. Seven studies were carried out during pregnancy complicated by PE, 10 were carried out up to 10 years postpartum and three included measurements obtained at both time periods. Women who had PE had significantly higher CIMT than did those who did not have PE, both at the time of diagnosis (SMD, 1.10 (95% CI, 0.73-1.48); P < 0.001) and in the first decade postpartum (SMD, 0.58 (95% CI, 0.36-0.79); P < 0.001). CONCLUSIONS Atherosclerotic load is present at the time of PE and may be a mechanism associated with the disease. Measurement of CIMT may offer an opportunity for the early identification of premenopausal women with atherosclerotic burden after a PE pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Natasa M. Milic
- Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia, Mayo Clinic, Rochester, MN 55905, USA
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Jelena Milin-Lazovic
- Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia, Mayo Clinic, Rochester, MN 55905, USA
| | - Tracey L. Weissgerber
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Goran Trajkovic
- Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia, Mayo Clinic, Rochester, MN 55905, USA
| | - Wendy M. White
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vesna D. Garovic
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
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Grand’Maison S, Pilote L, Okano M, Landry T, Dayan N. Markers of Vascular Dysfunction After Hypertensive Disorders of Pregnancy. Hypertension 2016; 68:1447-1458. [DOI: 10.1161/hypertensionaha.116.07907] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/28/2016] [Accepted: 09/12/2016] [Indexed: 12/15/2022]
Abstract
Women with prior hypertensive disorders of pregnancy (HDP) are at twice the risk of cardiovascular disease compared with women with prior normotensive pregnancy, possibly because of sustained vascular dysfunction after delivery. The aim of this systematic review and meta-analysis is to summarize evidence of vascular dysfunction at least 3 months after HDP. Articles in all languages were retrieved from principal databases. Studies included were observational, with HDP as the main exposure and measurements of vascular dysfunction via imaging modalities or serum biomarkers as the main outcome, assessed at least 3 months postpartum. We pooled results of modalities reported in >3 studies using a random effects model. Of 6109 potentially relevant studies, 72 were included that evaluated 10 imaging modalities and 11 serum biomarkers in 8702 women. There was evidence of vascular dysfunction in women post HDP compared with women with prior normal pregnancy when measured by carotid-femoral pulse wave velocity (0.64 m/s [0.17–1.11]), carotid intima–media thickness (0.025 mm [0.004–0.045]), and augmentation index (5.48% [1.58–9.37]), as well as mean levels of soluble fms-like tyrosine kinase (6.12 pg/mL [1.91–10.33]). Between-groups differences in measures of vascular dysfunction were more pronounced when assessments were performed in younger women (<40 years) or closer to the index pregnancy for almost all modalities. In conclusion, pooled data from studies evaluating vascular imaging suggest that some vascular dysfunction persists after HDP as compared with women with prior normal pregnancy.
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Affiliation(s)
- Sophie Grand’Maison
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Louise Pilote
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Marisa Okano
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Tara Landry
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Natalie Dayan
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
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Alterations to the maternal circulating proteome after preeclampsia. Am J Obstet Gynecol 2015; 213:853.e1-9. [PMID: 26476107 DOI: 10.1016/j.ajog.2015.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/03/2015] [Accepted: 10/07/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The long-term maternal cardiovascular and metabolic implications associated with preeclampsia (PE) include risk of hypertension, heart disease, and metabolic syndrome. The objective of this study was to investigate if a recent history of PE was associated with detectable alterations in the circulating maternal proteome. STUDY DESIGN Six-month postpartum plasma from women with a history of PE (n = 12) and women with uncomplicated obstetrical history (n = 12) were used for analysis. Depleted maternal plasma was analyzed by label-free liquid chromatography-mass spectrometry assay. Identified peptides were searched against the International Protein Index human database version 3.87. Exponentially modified protein abundance indices were used for comparison. Results were analyzed using pathway analysis software. RESULTS A total of 126 eligible peptides were identified for analysis; 3 peptides were differentially expressed in the PE proteome, and an additional 5 peptides were unique to control subjects and 7 to PE subjects. PE peptide profiles were more strongly associated with markers of coagulation and complement activation compared to controls and mapped more significantly to cardiovascular disease (CVD) functions. Stratification of subjects by low (<39%) and high (≥39%) lifetime risk of CVD rather than by diagnosis produced similar findings. Comparison of controls (n = 6) to PE subjects (n = 6) without traditional cardiovascular risk factors found that while similar for body mass indices, blood pressure, and fasting lipid profiles at 6 months postpartum, PE peptide profiles continued to display stronger associations for coagulation and CVD functions. Global network analysis found that unique peptides to low-risk PE subjects were associated with cardiac infarction, CVD, and organismal injury and abnormalities. CONCLUSION Markers of CVD risk and progression are evident in the maternal circulating proteome 6 months postpartum after PE. Augmentations in circulating peptide profiles occur in patients with previous PE who otherwise do not have clinically measurable cardiovascular risk factors. Our data highlight the need for the implementation of postpartum prevention programs in the PE population and identifies molecules that may be targeted for screening or therapeutic benefit.
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Stergiotou I, Bijnens B, Cruz-Lemini M, Figueras F, Gratacos E, Crispi F. Maternal subclinical vascular changes in fetal growth restriction with and without pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:706-712. [PMID: 25678131 DOI: 10.1002/uog.14815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/31/2015] [Accepted: 02/06/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess maternal vascular structure and function in pregnancies complicated by fetal growth restriction (FGR), in women with and without pre-eclampsia (PE) at the time of FGR diagnosis. METHODS We evaluated 124 women with a pregnancy complicated by FGR, of whom 60 had PE and 64 did not, and compared these findings to those of 110 normal women (controls). The group of FGR pregnancies without PE was further subdivided according to gestational age at FGR diagnosis into early onset (< 32 weeks) or late onset (≥ 32 weeks). Maternal carotid intima-media thickness (IMT), blood pressure (BP), carotid artery distensibility (CD), circumferential wall stress (CWS) and inferior vena cava (IVC) collapsibility were assessed by ultrasound at the time of FGR diagnosis. RESULTS Compared to controls, cases of FGR with PE showed increased maternal carotid IMT (0.425 (interquartile range (IQR), 0.381-0.486) vs 0.409 (IQR, 0.386-0.439) mm; P = 0.021), BP (mean, 109 (IQR, 101-117) vs 82 (IQR, 77-89) mmHg; P < 0.001) and CWS (19.7 (IQR, 17.0-22.7) vs 12.2 (IQR, 11.1-13.7) kPa; P < 0.001), and reduced CD (25.3 (IQR, 15.7-35.6) vs 31.9 (IQR, 25.4-41.1) kPa(-1) × 10(-3) ; P = 0.037) and IVC collapsibility indices (0.07 (IQR, 0.06-1.11) vs 0.10 (IQR, 0.06-0.13); P = 0.136). Similarly, compared to controls, in cases of FGR without PE maternal carotid IMT (0.436 (IQR, 0.392-0.476) mm; P = 0.001) and BP (88 (IQR, 81-95) mmHg; P < 0.001) were increased but CD and IVC collapsibility were similar. When analysis was subclassified according to gestational age at diagnosis, IMT and CWS were significantly increased only in early-onset FGR while BP was increased in both groups. CONCLUSION Normotensive women with pregnancy complicated by FGR share some subclinical vascular features with those of women with PE, which further reinforces the notion that, at least in a proportion of cases, there is a common placental disease that influences maternal cardiovascular features.
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Affiliation(s)
- I Stergiotou
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - B Bijnens
- ICREA, Universitat Pompeu Fabra, Barcelona, Spain
| | - M Cruz-Lemini
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacos
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Gaibazzi N, Rigo F, Facchetti R, Carerj S, Giannattasio C, Moreo A, Mureddu GF, Salvetti M, Grolla E, Faden G, Cesana F, Faggiano P. Differential incremental value of ultrasound carotid intima-media thickness, carotid plaque, and cardiac calcium to predict angiographic coronary artery disease across Framingham risk score strata in the APRES multicentre study. Eur Heart J Cardiovasc Imaging 2015; 17:991-1000. [PMID: 26358694 DOI: 10.1093/ehjci/jev222] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022] Open
Abstract
AIMS According to recent data, more accurate selection of patients undergoing coronary angiography for suspected coronary artery disease (CAD) is needed. From the Active PREvention Study multicentre prospective study, we further analyse whether carotid intima-media thickness (cIMT), carotid plaques (cPL), and echocardiographic cardiac calcium score (eCS) have incremental discriminatory and reclassification predictive value for CAD over clinical risk score in subjects undergoing coronary angiography, specifically depending on their low, intermediate, or high class of clinical risk. METHODS AND RESULTS In eight centres, 445 subjects without history of prior CAD but with chest pain of recent onset and/or a positive/inconclusive stress test for ischaemia prospectively underwent clinically indicated elective coronary angiography after cardiac and carotid ultrasound assessments with measurements of cIMT, cPL, and eCS. The study population was divided into subjects at low (10%), intermediate (10-20%), and high (>20%) Framingham risk score (FRS). Ultrasound parameters were tested for their incremental value to predict CAD over FRS, in each pre-test risk category. No significant difference could be appreciated between the discrimination value of FRS and Diagnostic Imaging for Coronary Artery Disease score for the presence of CAD. eCS or cPL demonstrated significant incremental prediction over FRS, consistently in the three FRS categories (P < 0.01); this applied to both discrimination and reclassification, with the exception of high-risk subjects, in whom cPL was apparently not incremental over FRS, and eCS was only of borderline significance for better discrimination. CONCLUSIONS Ultrasound eCS and cPL assessments were significant predictors of angiographic CAD in patients without prior CAD but with signs or symptoms suspect for CAD, independently and incrementally to FRS, across all pre-test risk probability strata, although in high-risk subjects, only eCS maintained an incremental value. The use of cIMT was not significantly incrementally useful in any FRS risk category.
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Affiliation(s)
- Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Via Gramsci, 14, Parma 43124, Italy
| | | | - Rita Facchetti
- Niguarda Ca' Granda Hospital and Milano-Bicocca University, Milan, Italy
| | | | | | - Antonella Moreo
- Niguarda Ca' Granda Hospital and Milano-Bicocca University, Milan, Italy
| | | | | | | | | | - Francesca Cesana
- Niguarda Ca' Granda Hospital and Milano-Bicocca University, Milan, Italy
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Hou Y, Yuan LJ, Xing CY, Shang FJ, Duan YY. Carotid Arterial Stiffness in Patients with Congenital Heart Disease-Related Pulmonary Hypertension Assessed with Radio Frequency Data Technique. Echocardiography 2015; 32:1676-80. [PMID: 25732062 DOI: 10.1111/echo.12925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It has been well known that pulmonary hypertension (PH) caused by congenital heart disease (CHD) leads to reduced flexibility of the small pulmonary arteries, due to hemodynamic changes in the pulmonary circulation and alterations of the vasoactive profile. However, whether CHD-related PH affects the elasticity of the systemic arteries, such as the common carotid artery (CCA), has not been fully investigated. The purpose of this study was to explore the CCA stiffness in patients with CHD-related PH using the radio frequency data technique. METHODS Forty patients with CHD were included. They were divided into PH and non-PH (NPH) groups by the right heart catheter-determined or regurgitation velocity-determined mean pulmonary arterial pressure (mPAP). MyLabTwice (Esaote, Genoa, Italy) ultrasound machine equipped with automatic quality intima-media thickness (QIMT) and quality arterial stiffness (QAS) capabilities was used to measure the left common carotid arterial (CCA) intima-media thickness and arterial stiffness parameters. RESULTS The results have shown that the left CCA internal diameter, pulse wave velocity, arterial wall tension, and local diastolic pressure were increased in the CHD-related PH group compared with the CHD-related NPH group (all P < 0.05). The left CCA internal diameter negatively and significantly correlated with the mean PAP. CONCLUSIONS Common carotid artery diameter and stiffness increase in patients with CHD-related pulmonary hypertension. QIMT and QAS ultrasound techniques may provide a comprehensive assessment of the CCA remodeling.
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Affiliation(s)
- Ying Hou
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Li-Jun Yuan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Chang-Yang Xing
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Fu-Jun Shang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yun-You Duan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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Niu L, Zhang Y, Meng L, Xiao Y, Wong KKL, Abbott D, Zheng H, Zheng R, Qian M. Detection of subclinical atherosclerosis in asymptomatic subjects using ultrasound radiofrequency-tracking technology. PLoS One 2014; 9:e111926. [PMID: 25369320 PMCID: PMC4219816 DOI: 10.1371/journal.pone.0111926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/29/2014] [Indexed: 11/18/2022] Open
Abstract
Objective Atherosclerosis is a chronic and systemic disease and its developmental process involves the synergism of multiple risk factors such as hypertension, dyslipidemia, diabetes, obesity and smoking. The diagnosis of subclinical atherosclerosis is essential for strategic guidance towards suitable treatments and efficient prevention against acute cardiovascular events. This study employed ultrasound radiofrequency (RF) tracking technology to characterize human carotid arteries in vivo in terms of intima-media thickness (IMT) and artery stiffness, and evaluated the statistical correlation between carotid IMT and stiffness, and the number of risk factors for atherosclerosis. Methods A total of 160 asymptomatic subjects were enrolled. Ultrasound RF-tracking technology was employed to acquire carotid IMT and stiffness parameters: maximum IMT (MAXIMT), RF Quality IMT (RFQIMT), distensibility coefficient (), compliance coefficient (), index, index and local pulse wave velocity (). The subjects were categorized in four groups in terms of the number of risk factors: ‘zero’, ‘single’, ‘double’, and ‘multiple’, and statistical analyses of carotid IMT and stiffness parameters were performed between these different groups. Results The subjects (n = 145) with MAXIMT smaller than 1.0 mm matched the IMT criteria for non-atherosclerosis and were named as NA-subjects. Spearman’s rho correlation analysis of the whole group and the NA-subjects both showed that MAXIMT correlated positively with RFQIMT, , , and , and negatively with and (p<0.01). The analysis of covariance of NA-subjects showed significant differences between subjects with and without risk factors, and also showed significant differences between the ‘zero’, ‘single’, ‘double’, and ‘multiple’ groups. Conclusions The carotid IMT and stiffness parameters obtained by the ultrasound RF-tracking technology were demonstrated to possess significant statistical correlation with the number of risk factors from 160 subjects, and these anatomical and mechanical parameters may potentially be used together with the IMT criteria to support subclinical atherosclerosis diagnosis.
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Affiliation(s)
- Lili Niu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yanling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Long Meng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yang Xiao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Kelvin K. L. Wong
- Centre for Biomedical Engineering, and School of Electrical & Electronic Engineering, University of Adelaide, Adelaide, Australia
| | - Derek Abbott
- Centre for Biomedical Engineering, and School of Electrical & Electronic Engineering, University of Adelaide, Adelaide, Australia
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- * E-mail: (HZ); (RZ); (MQ)
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- * E-mail: (HZ); (RZ); (MQ)
| | - Ming Qian
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- * E-mail: (HZ); (RZ); (MQ)
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Galjaard S, Pasman SA, Ameye L, Timmerman D, Devlieger R. Intima-media thickness measurements in the fetus and mother during pregnancy: a feasibility study. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1949-1957. [PMID: 24882524 DOI: 10.1016/j.ultrasmedbio.2014.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 06/03/2023]
Abstract
Fetal intima-media thickness (IMT) has been suggested as a marker of pre-clinical atherosclerosis, and maternal IMT could be altered through dynamic circumstances related to pregnancy. We investigated the feasibility of measurement of IMT at four pre-defined fetal and four pre-defined maternal arterial locations to determine vascular changes that could be associated with impaired vascular function. IMT was measured from the first to third trimester (12-34 wk), in 38 low-risk pregnancies. We imaged a 10-mm region of interest using a Mindray (Shenzhen, China) high-resolution ultrasound machine with automated IMT measurement software. Fetal abdominal aorta IMT was measurable during the second trimester in 71% and during the third trimester in 100% of the case, and umbilical artery IMT was measurable in 50% and 82% of cases during the second and third trimesters, respectively. Fetal IMT measurements were not possible during the first trimester. It was not often feasible to measure the IMT of the fetal common carotid artery, fetal renal artery and maternal iliac artery (maximal 20% of cases). Maternal common carotid artery, abdominal aorta and uterine artery IMTs were measurable throughout pregnancy. There was a significant relation between gestational age and IMT in the umbilical artery (p = 0.03) and a significant relation between body mass index and IMT in the maternal common carotid artery (p = 0.01). IMT measurements are feasible in some maternal and fetal vessels of interest. Further studies are underway to obtain more insight into vascular development during normal and pathologic pregnancies.
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Affiliation(s)
- Sander Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Suzanne A Pasman
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Lieveke Ameye
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, Leuven, Belgium
| | - Dirk Timmerman
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.
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Ciftci FC, Caliskan M, Ciftci O, Gullu H, Uckuyu A, Toprak E, Yanik F. Impaired coronary microvascular function and increased intima-media thickness in preeclampsia. ACTA ACUST UNITED AC 2014; 8:820-6. [PMID: 25455007 DOI: 10.1016/j.jash.2014.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/26/2014] [Accepted: 08/18/2014] [Indexed: 11/19/2022]
Abstract
There is an association between preeclampsia (PE) and excessive morbidity and mortality. Some recent studies have revealed the presence of endothelial dysfunction in PE patients with inflammatory activity. Moreover, it has been argued that the chronic inflammatory state involved in PE leads to an acceleration in atherosclerosis. Accordingly, our goal in this study is to determine whether there is any coronary microvascular dysfunction and increase in the intima-media thickness in patients who had mild PE 5 years before, without the presence of any traditional cardiovascular risk factors. The study included 33 mild PE patients (mild preeclampsia is classified as a blood pressure (BP) of 140/90 mm Hg or higher with proteinuria of 0.3 to 3 g/d) whose mean age was 33.7 years old, and 29 healthy women volunteers whose mean age was 36.1 years old. Each subject was examined using transthoracic echocardiography 5 years after their deliveries. During the echocardiographic examination, coronary flow reserve (CFR) and carotid intima-media thickness (IMT) were measured. There was a statistically lower CFR value in PE patients as compared with controls (2.39 ± 0.48 vs. 2.90 ± 0.49; P < .001). On the other hand, there was a significant increase in their IMT and high-sensitivity C-reactive protein (hs-CRP) values (respectively, 0.59 ± 0.15 vs. 0.46 ± 0.10; P < .001 and 3.80 ± 2.10 vs. 2.33 ± 1.79; P = .004). There was a negative correlation between the CFR values of the PE patients and hs-CRP (r = -0.568; P = .001) and IMT (r = -0.683, P < .001) results.We determined in the study that there was impaired CFR and increased carotid IMT in patients with PE, and, moreover, that these adverse effects were significantly correlated with hs-CRP.
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Affiliation(s)
- Faika C Ciftci
- Department of Obstetrics and Gynocology, Baskent University, Ankara, Turkey.
| | | | - Ozgur Ciftci
- Department of Cardiology, Baskent University, Ankara, Turkey
| | - Hakan Gullu
- Department of Cardiology, Baskent University, Ankara, Turkey
| | - Ayla Uckuyu
- Department of Obstetrics and Gynocology, Baskent University, Ankara, Turkey
| | - Erzat Toprak
- Department of Obstetrics and Gynocology, Baskent University, Ankara, Turkey
| | - Filiz Yanik
- Department of Obstetrics and Gynocology, Baskent University, Ankara, Turkey
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Akhter T, Larsson M, Wikström AK, Naessen T. Thicknesses of individual layers of artery wall indicate increased cardiovascular risk in severe pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:675-680. [PMID: 24375803 DOI: 10.1002/uog.13289] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/05/2013] [Accepted: 12/11/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess whether thicknesses of the intima and media in the common carotid artery (CCA) and the intima/media ratio (I/M) indicate an increased cardiovascular risk in non-pregnant women with a history of previous severe pre-eclampsia. METHODS Thicknesses of the CCA intima and media layers were measured using non-invasive high-frequency (22 MHz) ultrasound in 42 women with a history of severe pre-eclampsia and 44 women with previous normal pregnancy. RESULTS Women with a history of severe pre-eclampsia had a thicker CCA intima and a higher I/M than had women with previous normal pregnancy, also after adjustment for mean arterial pressure, body mass index and CCA intima-media thickness (IMT) (all P < 0.0001). CCA-IMT did not differ significantly between groups. In receiver-operating characteristics curve analysis, intima thickness and I/M clearly discriminated between women with and those without previous pre-eclampsia (area under the receiver-operating characteristics curve (AUC), 0.98 and 0.93), whereas CCA-IMT did not (AUC, 0.52). CONCLUSIONS CCA individual intima and media thicknesses as well as I/M, but not CCA-IMT, reflect the known increased long-term cardiovascular risk of pre-eclampsia. Estimation of individual CCA layers using high-frequency ultrasound appears preferable to measuring CCA-IMT for investigating arterial effects and the increased cardiovascular risk in women with a history of severe pre-eclampsia.
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Affiliation(s)
- T Akhter
- Department of Women's and Children's Health, Section for Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
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Yuan LJ, Duan YY, Xue D, Cao TS, Zhou N. Ultrasound study of carotid and cardiac remodeling and cardiac-arterial coupling in normal pregnancy and preeclampsia: a case control study. BMC Pregnancy Childbirth 2014; 14:113. [PMID: 24666973 PMCID: PMC4000894 DOI: 10.1186/1471-2393-14-113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 03/07/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cardiovascular adaptions, such as cardiac and uterine spiral arterial remodeling, and aortic arterial stiffening during pregnancy have been extensively investigated, while the interactions between the elastic artery and the left ventricle are poorly understood. This study was to evaluate the cardiac-arterial coupling in both normal pregnancy and preeclampsia using ultrasound techniques. METHODS Twenty-three preeclamptic women with no antihypertensive treatment prior to admission, and 40 age- (27.2 ± 3.0 y vs. 29.1 ± 5.7 y, p = 0.0805) and gestational week- (35.6 ± 3.4 wk vs. 34.8 ± 3.6 wk, p = 0.3573) matched normotensive pregnant women were included. All women signed informed consent. All were nulliparas, had singleton pregnancies, and had no other risk factors for arterial stiffening. Carotid and cardiac ultrasound was performed using a MylabTwice ultrasound unit (Esaote, Italy). Cardiac and carotid remodeling and their associations were analyzed. Left ventriculo-carotid coupling was characterized by the ratio between the arterial elastance (Ea) and the left ventricular systolic elastance (Ees). Follow-up study was performed 16-20 months after parturition. RESULTS Left ventricular and carotid arterial remodeling was seen more frequently in preeclamptic women than in normal pregnant controls (96% vs. 40%, 82% vs. 48%, both p < 0.0001). The relative carotid arterial wall thickness showed no significant difference between the two groups. However, the carotid cross-sectional area, a surrogate for carotid arterial mass, was significantly greater in preeclampsia than that in normal controls (11.23 ± 0.17 mm2 vs. 8.58 ± 1.88 mm2, p < 0.00001). Carotid arterial stiffness and intima-media thickness correlated significantly with cardiac diastolic function parameters and blood pressures (p < 0.05). Both Ea and Ees were significantly greater in preeclampsia, compared with values in normal pregnant controls (Ea: 2.41 ± 0.57 mmHg/ml vs. 1.98 ± 0.46 mmHg/ml, p = 0.0005; Ees: 11.68 ± 9.51 m/s2 vs. 6.91 ± 6.13 m/s2, p = 0.002). However, there was no significant difference in the left ventriculo-carotid coupling index, Ea/Ees, between the two groups. Carotid remodeling persisted in both preeclamptic women and normal pregnant controls 16-20 months after parturition. CONCLUSIONS Significant cardiac and carotid remodeling and similar left ventriculo-carotid coupling were observed in both preeclampsia and normal pregnancy. Carotid remodeling may persist postpartum. Further studies with larger populations are needed to confirm these findings.
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Affiliation(s)
- Li-Jun Yuan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, China
| | - Yun-You Duan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, China
| | - Dan Xue
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, China
| | - Tie-Sheng Cao
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, China
| | - Ning Zhou
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, China
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Stergiotou I, Crispi F, Valenzuela-Alcaraz B, Bijnens B, Gratacos E. Patterns of maternal vascular remodeling and responsiveness in early- versus late-onset preeclampsia. Am J Obstet Gynecol 2013; 209:558.e1-558.e14. [PMID: 23911383 DOI: 10.1016/j.ajog.2013.07.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/18/2013] [Accepted: 07/27/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We sought to assess vascular structure and function in early- and late-onset preeclampsia (PE) at the time of diagnosis. STUDY DESIGN We evaluated 100 PE cases subdivided into 50 early- and 50 late-onset cases according to gestational age at onset (</>34 weeks), and 100 controls paired by maternal age and gestational age at scan with cases. Carotid intima-media thickness (IMT), distensibility, and circumferential wall stress together with inferior vena cava (IVC) collapsibility were assessed by ultrasound. RESULTS Early PE was characterized by increased carotid IMT diameters, and arterial stiffness with no significant changes in IVC parameters as compared to normotensive pregnancies. Late PE was characterized by significantly increased carotid IMT and lumen diameters as compared to controls while arterial stiffness, as expressed by distensibility, did not provide pronounced changes. A significant decrease of IVC collapsibility index was also observed in late PE as compared to controls. CONCLUSION The current data suggest that distinct vascular adaptations in early and late PE could reflect different pathophysiologic mechanisms. Future studies are warranted to further assess the complex etiologies and clinical expressions of the 2 entities.
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Affiliation(s)
- Iosifina Stergiotou
- Department of Maternal-Fetal Medicine, Instituto Clinic de Ginecología, Obstetricia y Neonatología, Hospital Clinic, Universitat de Barcelona, the Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomediques August Pi i Sunyer, and the Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
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Yuan LJ, Xue D, Duan YY, Cao TS, Zhou N. Maternal carotid remodeling and increased carotid arterial stiffness in normal late-gestational pregnancy as assessed by radio-frequency ultrasound technique. BMC Pregnancy Childbirth 2013; 13:122. [PMID: 23710816 PMCID: PMC3669620 DOI: 10.1186/1471-2393-13-122] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 05/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The adaption of elastic arteries to transient increase in hemodynamic load in normal pregnancy (NP) remains controversial. The purpose of this study was to investigate the NP carotid remodeling and regional arterial stiffness before and after parturition. METHODS Fifty-one NP women and 30 age-matched non-pregnant women were included. All women underwent right common carotid artery (RCCA) measurements with MylabTwice ultrasound instrument (Esaote, Italy). Carotid intima-medial thickness (IMT), pulse wave velocity (PWV, m/s), distensibility coefficient (DC, 1/KPa), α, β, augmentation index (AIx, %) and carotid arterial pressure were obtained by the newly developed ultrasound vascular wall tracking methods: automatic QAS (Quality Arterial Stiffness) and QIMT (Quality Intima-Medial Thickness) Follow up study was performed. RESULTS Compared to the non-pregnant controls, the arterial pressures were significantly increased and RCCA diameter was significantly enlarged in late gestational NP women. Twenty months after parturition, carotid diameter, DC, AIx, PWV and arterial wall tension were significantly decreased and had no significant difference with those in non-pregnant controls. CONCLUSIONS Carotid arterial remodeling and stiffening could be seen in the normal pregnant women, which seems to be a physiological adaption and could be recovered post partum. QIMT and QAS together could provide a comprehensive assessment of the maternal carotid arterial changes during pregnancy.
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Affiliation(s)
- Li-Jun Yuan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
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