Persistent Postpartum Cardiovascular Dysfunction in Patients With Preeclampsia

Study Overview
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Brief Summary
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The investigators plan to enroll women with PE prospectively to evaluate incremental cardiovascular risk in those who have PE with severe features. This study includes detailed echocardiographic evaluation at several time points. With the current proposal, the investigators aim to collect blood to evaluate several biomarkers to determine if there is a correlation with short and medium-term cardiovascular risk. This opens the door to earlier detection, treatment and improved cardiovascular outcomes.

Detailed Description
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Preeclampsia (PE) is a multi-system progressive disorder affecting up to 8% of pregnancies. Epidemiologic studies have shown a significant association between PE and future cardiovascular disease (CVD) in women. Despite recognition of this relationship, there are no good markers to help determine which women are at highest risk, in particular as this relates to long-term cardiovascular risk, the number one cause of mortality in U.S. born women. As such, the study of PE and cardiovascular outcomes, in particular to identify early markers for the development of late CVD, provide insight into critical opportunities for early treatment and modification of disease trajectory in women. The investigators plan to enroll women with PE prospectively to evaluate incremental cardiovascular risk in those who have PE with severe features. This study includes detailed echocardiographic evaluation at several time points. With the current proposal, the investigators aim to collect blood to evaluate several biomarkers to determine if there is a correlation with short and medium-term cardiovascular risk. This opens the door to earlier detection, treatment and improved cardiovascular outcomes. The investigators hypothesize that preeclampsia with severe features confers a much higher risk of cardiovascular impairment compared to milder form of preeclampsia and healthy controls. If the hypothesis proves correct, these findings may change clinical practice by warranting routine echocardiogram for these patients for early recognition, intervention and treatment of cardiac dysfunction.

Official Title
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Persistent Postpartum Cardiovascular Dysfunction in Patients With Preeclampsia

Conditions
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Preeclampsia Severe or Mild, Cardiac Complication

Intervention / Treatment
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* Diagnostic Test: Echocardiogram
* Diagnostic Test: Blood draw


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Females older than 18 years of age Singleton pregnancy The patient is physically and mentally able to understand the informed consent and is willing to participate in this study Able to speak English Must meet one of the population categories, until each group has reached 20 subjects Exclusion Criteria: Multiple gestation History of chronic hypertension or cardiac disease including but not limited to history of heart arrhythmias, congenital heart disease, and use of any cardiac medication (such as beta blockers, ACE inhibitors, calcium channel blockers) prior to pregnancy. History of medical problems that may contribute to cardiac dysfunction, including but not limited to chronic hypertension, poorly controlled hyperthyroidism and diabetes mellitus.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Preeclampsia<br>40 patients diagnosed with preeclampsia with or without severe features | Diagnostic Test: Echocardiogram<br>* Serial echocardiograms will be done on all patients pre-delivery, and at 3-6 months<br>Diagnostic Test: Blood draw<br>* Serial blood draws at same time points as echocardiograms for biomarker levels<br>|
| Control<br>20 Control group of patients without hypertensive disorders of pregnancy | Diagnostic Test: Echocardiogram<br>* Serial echocardiograms will be done on all patients pre-delivery, and at 3-6 months<br>Diagnostic Test: Blood draw<br>* Serial blood draws at same time points as echocardiograms for biomarker levels<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cardiac dysfunction | The following parameters will be measured to assess cardiac dysfunction: LV Size/function Biplane Method of Disks LVEF (a4C and 2C views for EDV and ESV) LV Fractional shortening- Septal thickness and PW thickness LV Strain- Basal longitudinal, Mid LV longitudinal, Apical LV longitudinal and Global LV longitudinal strain 3D LV EF Tei index Analysis of LV diastolic function- Mitral E wave, Mitral A wave, Mitral e', Mitral E/e', Mitral E/A and Mitral Decel time LA volume RA volume IVC size/compressibility with inspiration RV size/function RV length RV basal width RV FAC % TAPSE S' Tei index TR velocity RVSP TAPSE Longitudinal strain- Basal Longi, Basal longitudinal, Mid LV longitudinal, Apical LV longitudinal and Global LV longitudinal strain Basic valve assessment | From delivery up to 3-6 months postpartum |