5 Myocardial performance index and anti angiogenic factors among women with preeclampsia: Hemodynamics

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• 作者：Hadi Ramadan^a ; Sarosh Rana^a ; Ariel Mueller^b ; Diego Medvedofsky^a ; Junaid Nizamuddin^a ; Surichhya Bajracharya^a ; Saira Salahuddin^b ; Ravi Thadhani^c ; Avery Tung^a ; Zoltan Arany^d ; S. Ananth Karumanchi^b ; Sajid Shahul^a
• 刊名：Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：6
• 期：3
• 页码：180
• 全文大小：38 K

文摘

Soluble anti angiogenic proteins have been known to be elevated in women with preeclampsia and have been associated with worsening systolic and diastolic function. Myocardial performance index (MPI) also known as the TEI Index is a tissue Doppler derived measure of global cardiac function that is used to assess both systolic and diastolic function. MPI is defined as the sum of the Isovolumic contraction time and the Isovolumic relaxation time divided by the ejection time. Smaller MPI values signify shorter relative Isovolumic contraction or relaxation times and thus indicate better overall function. Physiologically, left ventricular systolic function is better when a greater fraction of systolic time is spent ejecting rather than in isovolumic contraction. Similarly, better diastolic function is represented by a greater portion of diastole spent filling rather than in isovolumic relaxation. Previous work has demonstrated that cardiac time intervals are sensitive markers of subclinical cardiac dysfunction despite there being no changes detected by conventional echocardiography. In contrast to ejection fraction, MPI is independent of ventricular geometry, preload and heart rate.

Objective

The purpose of this study was to study myocardial performance index among women with preeclampsia and correlate MPI with circulating anti angiogenic factor levels.

Methods

One hundred twenty one women with diagnosis of preeclampsia (n = 48), normal pregnancy (n = 73) were studied. Plasma was collected and levels of anti angiogenic proteins (soluble fms like tyrosine kinase- sFlt1 and soluble endoglin sEng) were measured using enzyme linked immune sorbent assay. All patients had an echocardiogram performed at the time of diagnosis. Blood sample were collected within 24 hours of echocardiogram.

Results

Patients with preeclampsia had higher mean sFlt1 (pg/ml) and sEng (ng/ml) compared to normal patients (19243 vs 3816 and 47 vs 11, respectively, both p < 0.001). Preeclamptic patients had higher MPI compared to normal patients (0.48 vs 0.44, p = 0.04). Worsening MPI was significantly correlated to increasing sFlt1 (p = 0.04) and sEng levels (p = 0.03). In addition we found worsening left ventricular relaxation times to be correlated with increasing sFlt1 and sEng levels (both p < 0.001).

Discussion/conclusion

Worsening myocardial performance as measured by MPI was seen among women with preeclampsia and these changes correlated with increasing antiangiogenic factors like sFlt1 and sEng. Further studies are needed to validate these findings and evaluate whether these changes remain persistent postpartum.