Cardiac involvement in pre-eclampsia and eclampsia syndrome

Of the various complications of pregnancy, pregnancy-induced hypertension, pre-eclampsia and eclampsia syndrome (PE-EC) represent the most prevalent and potentially the most serious events. The adverse effects on the cardiovascular system in PE-EC syndrome comprise hypertension-induced left ventricular (LV) hypertrophy, LV diastolic dysfunction, LV failure, cerebral oedema, renal involvement and cardiac arrest.

The present study is intended to assess the prevalence of cardiac involvement in PE-EC syndrome and the prognostic implications therefrom. Out of a total 70 females (mean age 26.8 ± 7.4 years) referred from the obstetric section to the Critical Care Center to handle various crises, 38 had PE-EC and 32 had no PE-EC. Following clinical evaluation, all patients were subjected to routine laboratory tests, ECG and echocardiography with follow-up during hospitalization. Hypertension was defined as blood pressure (BP) > 160/100 mmHg.

Out of 38 patients with PE-EC, underlying heart disease (HD) was present in five patients (13%) (peripartum cardiomyopathy in one and rheumatic HD in four), and 33 had no underlying HD. Of 32 patients having no PE-EC, 20 (62%) had underlying HD (11 rheumatic HD, five peripartum cardiomyopathy, two ischemic HD, one congenital HD, and one ventricular tachycardia).

Compared with the noneclamptic group, those with PE-EC syndrome exhibited a higher prevalence of hypertension (mean systolic BP 160 ± 62.4 vs 93.4 ± 23.1 and mean diastolic BP 104 ± 29.7 vs 65.6 ± 23.4, P < 0.05). Nevertheless, LV systolic function expressed as depressed ejection fraction (EF)< 40% was insignificantly worse in the noneclamptic group compared with the PE-EC subset with a mean EF of 32.5 ± 4.5 vs 34.3 ± 6.08, respectively.

However, out of 38 patients with PE-EC syndrome 13 (32%) died, vs five patients (16%) out of 32 in the noneclamptic group. Mortality was due to cerebrovascular stroke in six patients, antepartum hemorrhage in four, systemic inflammatory syndrome in three, acute pulmonary edema in three and renal failure in nine patients.

Conclusion

Despite the relatively few cases of underlying HD in the PE-EC obstetric patients referred, the insignificantly lesser prevalence of depressed LV systolic function despite the higher BP, yet the greater incidence of mortality compared with the noneclamptic syndrome clearly point to the malignant nature of the PE-EC syndrome and raise the issue of early diagnosis and need for early intervention. The cardiovascular involvement in PE-EC syndrome is apparently related to hypertension-induced target organ damage and at best would represent a marker, pointing to the seriousness of pre-eclampsia syndrome in terms of mortality and adverse cardiac events.