Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness
Background: Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with high maternal and fetal morbidity and mortality and increased future risk of cardiovascular complications. Objective: To analyze whether women who have had PE with severe features in their pregnancy have higher art...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-11-01
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| Series: | Nefrología (English Edition) |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2013251423001773 |
| _version_ | 1797326287224700928 |
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| author | Lara Belmar Vega José Luis Pérez Canga Milagros Heras Vicario Emilio Rodrigo Calabia Juan Carlos Ruiz San Millán Laura Díaz López Luis Martín Penagos Gema Fernández Fresnedo |
| author_facet | Lara Belmar Vega José Luis Pérez Canga Milagros Heras Vicario Emilio Rodrigo Calabia Juan Carlos Ruiz San Millán Laura Díaz López Luis Martín Penagos Gema Fernández Fresnedo |
| author_sort | Lara Belmar Vega |
| collection | DOAJ |
| description | Background: Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with high maternal and fetal morbidity and mortality and increased future risk of cardiovascular complications. Objective: To analyze whether women who have had PE with severe features in their pregnancy have higher arterial stiffness (AS) parameters than those whose PE course was without signs of severity. Methods: Sixty-five women who developed PE during their gestation were evaluated, divided into two groups: PE group without severe features or non-severe PE (n = 30) and PE group with severe features or severe PE (n = 35). Carotid-femoral pulse wave velocity (cfPWV), central augmentation index corrected to a heart rate of 75 beats per minute (AIxc75) and central augmentation pressure (cAP) were determined one month and six months postpartum. Comparison of proportions was carried out using the chi-square test, comparison of means between groups using the Student’s t-test or the Mann–Whitney test, and comparison of means of the same group at different evolutionary moments, using the t-test or the Wilcoxon test. Correlation, with and between hemodynamic parameters, was carried out with Spearman’s correlation coefficient and the association between demographic variables, personal history and hemodynamic parameters, and altered arterial stiffness parameters was carried out using linear and logistic regression models. Results: Women with severe PE presented, both at 1 and 6 months postpartum, higher values of blood pressure, both central and peripheral, as well as AR and pulse amplification parameters, than those women whose PE was not severe. Central augmentation index (cAIx) values at 1 month and 6 months postpartum were higher, although not significantly, in the severe PE group compared to the non-severe PE group (24.0 (16.5–34.3) vs. 19.0% (14–29) and 24.0 (14.0–30.0) vs. 20.0% (12.3–26.8), respectively). Carotid-femoral pulse wave velocity (cfPWV) was significantly higher at both 1 and 6 months postpartum in the severe PE group compared to the non-severe PE group (10.2 (8.8−10.7) vs. 8.8 m/s (8.3−9.6) and 10.0 (8.8−10.6) vs. 8.8 m/s (8.3−9.3), respectively). Central systolic pressure and central pulse pressure amplification were also higher, although not significantly, in the severe PE group in comparison with the non-severe PE group. Conclusions: Women who have had severe PE have more pronounced arterial stiffness parameters than those in whom PE was not particularly severe. The determination of cAIx and cfPWV, as a strategy for the assessment of cardiovascular risk, should be evaluated among women who have had PE. Resumen: Antecedentes: La preeclampsia (PE) es un trastorno hipertensivo del embarazo asociado a una elevada morbimortalidad materna y fetal, y un mayor riesgo futuro de complicaciones cardiovasculares. Objetivo: Analizar si las mujeres que han tenido PE grave en su embarazo presentan parámetros de rigidez arterial (RA) superiores a las de aquellas cuya PE cursó sin signos de gravedad. Métodos: Se evaluaron 65 mujeres que habían desarrollado PE durante su gestación, divididas en 2 grupos: grupo de PE sin criterios de gravedad o PE no grave (n = 30) y grupo de PE con criterios de gravedad o PE grave (n = 35). Se determinó la velocidad de onda de pulso carótida-femoral (VOPcf), el índice de aumento central normalizado a 75 latidos por minuto (IAc75) y presión de aumento central (PAc) al mes y a los 6 meses posparto. La comparación de proporciones se llevó a cabo mediante la prueba de Chi-cuadrado, la comparación de medias entre grupos se utilizaron la prueba t de Student o la prueba de Mann-Whitney, y la comparación de medias de un mismo grupo en momentos evolutivos diferentes, la prueba t para o el test de Wilcoxon. La correlación, con y entre parámetros hemodinámicos, se llevó a cabo con el coeficiente de correlación de Spearman y la asociación entre variables demográficas, antecedentes personales y parámetros hemodinámicos, y valores alterados de RA se llevó a cabo mediante modelos de regresión lineal y logística. Resultados: Las mujeres con PE grave presentaban, al mes y a los 6 meses posparto, valores de presión arterial, tanto central como periférica, así como parámetros de RA y amplificación de pulso, superiores a aquellas mujeres cuya PE no revistió gravedad. Los valores del índice de aumento central (IAc) al mes y a los 6 meses posparto fueron superiores, aunque no de forma significativa, en el grupo de PE grave respecto al grupo de PE no grave (24,0 [16,5–34,3] vs. 19,0% [14–29] y 24,0 [14,0–30,0] vs. 20,0% [12,3–26,8], respectivamente). La velocidad onda de pulso carótida-femoral (VOPcf) fue superior de forma significativa, tanto al mes como a los 6 meses posparto en el grupo de PE grave respecto al grupo de PE no grave (10,2 [8,8–10,7] vs. 8,8 m/s [8,3–9,6] y 10,0 [8,8–10,6] vs. 8,8 m/s [8,3–9,3], respectivamente). La amplificación de la presión sistólica central y de la presión de pulso central fueron también superiores, aunque no de forma significativa, en el grupo de PE grave respecto al de PE no grave. Conclusión: Las mujeres que han tenido PE grave presentan parámetros de RA más acusados que los de aquellas en las que la PE no revistió especial gravedad. Debiera evaluarse la conveniencia de incluir de forma rutinaria entre las mujeres que han tenido PE la determinación del IAc y especialmente la VOPcf, como estrategia de evaluación del riesgo cardiovascular. |
| first_indexed | 2024-03-08T06:21:09Z |
| format | Article |
| id | doaj.art-310e202495204b88a1f2f42d86abdc3f |
| institution | Directory Open Access Journal |
| issn | 2013-2514 |
| language | English |
| last_indexed | 2024-03-08T06:21:09Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Nefrología (English Edition) |
| spelling | doaj.art-310e202495204b88a1f2f42d86abdc3f2024-02-04T04:44:06ZengElsevierNefrología (English Edition)2013-25142023-11-01436703713Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffnessLara Belmar Vega0José Luis Pérez Canga1Milagros Heras Vicario2Emilio Rodrigo Calabia3Juan Carlos Ruiz San Millán4Laura Díaz López5Luis Martín Penagos6Gema Fernández Fresnedo7Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Corresponding author.Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, SpainServicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, SpainServicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, SpainServicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, SpainServicio de Obstetricia y Ginecología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, SpainServicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, SpainServicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, SpainBackground: Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with high maternal and fetal morbidity and mortality and increased future risk of cardiovascular complications. Objective: To analyze whether women who have had PE with severe features in their pregnancy have higher arterial stiffness (AS) parameters than those whose PE course was without signs of severity. Methods: Sixty-five women who developed PE during their gestation were evaluated, divided into two groups: PE group without severe features or non-severe PE (n = 30) and PE group with severe features or severe PE (n = 35). Carotid-femoral pulse wave velocity (cfPWV), central augmentation index corrected to a heart rate of 75 beats per minute (AIxc75) and central augmentation pressure (cAP) were determined one month and six months postpartum. Comparison of proportions was carried out using the chi-square test, comparison of means between groups using the Student’s t-test or the Mann–Whitney test, and comparison of means of the same group at different evolutionary moments, using the t-test or the Wilcoxon test. Correlation, with and between hemodynamic parameters, was carried out with Spearman’s correlation coefficient and the association between demographic variables, personal history and hemodynamic parameters, and altered arterial stiffness parameters was carried out using linear and logistic regression models. Results: Women with severe PE presented, both at 1 and 6 months postpartum, higher values of blood pressure, both central and peripheral, as well as AR and pulse amplification parameters, than those women whose PE was not severe. Central augmentation index (cAIx) values at 1 month and 6 months postpartum were higher, although not significantly, in the severe PE group compared to the non-severe PE group (24.0 (16.5–34.3) vs. 19.0% (14–29) and 24.0 (14.0–30.0) vs. 20.0% (12.3–26.8), respectively). Carotid-femoral pulse wave velocity (cfPWV) was significantly higher at both 1 and 6 months postpartum in the severe PE group compared to the non-severe PE group (10.2 (8.8−10.7) vs. 8.8 m/s (8.3−9.6) and 10.0 (8.8−10.6) vs. 8.8 m/s (8.3−9.3), respectively). Central systolic pressure and central pulse pressure amplification were also higher, although not significantly, in the severe PE group in comparison with the non-severe PE group. Conclusions: Women who have had severe PE have more pronounced arterial stiffness parameters than those in whom PE was not particularly severe. The determination of cAIx and cfPWV, as a strategy for the assessment of cardiovascular risk, should be evaluated among women who have had PE. Resumen: Antecedentes: La preeclampsia (PE) es un trastorno hipertensivo del embarazo asociado a una elevada morbimortalidad materna y fetal, y un mayor riesgo futuro de complicaciones cardiovasculares. Objetivo: Analizar si las mujeres que han tenido PE grave en su embarazo presentan parámetros de rigidez arterial (RA) superiores a las de aquellas cuya PE cursó sin signos de gravedad. Métodos: Se evaluaron 65 mujeres que habían desarrollado PE durante su gestación, divididas en 2 grupos: grupo de PE sin criterios de gravedad o PE no grave (n = 30) y grupo de PE con criterios de gravedad o PE grave (n = 35). Se determinó la velocidad de onda de pulso carótida-femoral (VOPcf), el índice de aumento central normalizado a 75 latidos por minuto (IAc75) y presión de aumento central (PAc) al mes y a los 6 meses posparto. La comparación de proporciones se llevó a cabo mediante la prueba de Chi-cuadrado, la comparación de medias entre grupos se utilizaron la prueba t de Student o la prueba de Mann-Whitney, y la comparación de medias de un mismo grupo en momentos evolutivos diferentes, la prueba t para o el test de Wilcoxon. La correlación, con y entre parámetros hemodinámicos, se llevó a cabo con el coeficiente de correlación de Spearman y la asociación entre variables demográficas, antecedentes personales y parámetros hemodinámicos, y valores alterados de RA se llevó a cabo mediante modelos de regresión lineal y logística. Resultados: Las mujeres con PE grave presentaban, al mes y a los 6 meses posparto, valores de presión arterial, tanto central como periférica, así como parámetros de RA y amplificación de pulso, superiores a aquellas mujeres cuya PE no revistió gravedad. Los valores del índice de aumento central (IAc) al mes y a los 6 meses posparto fueron superiores, aunque no de forma significativa, en el grupo de PE grave respecto al grupo de PE no grave (24,0 [16,5–34,3] vs. 19,0% [14–29] y 24,0 [14,0–30,0] vs. 20,0% [12,3–26,8], respectivamente). La velocidad onda de pulso carótida-femoral (VOPcf) fue superior de forma significativa, tanto al mes como a los 6 meses posparto en el grupo de PE grave respecto al grupo de PE no grave (10,2 [8,8–10,7] vs. 8,8 m/s [8,3–9,6] y 10,0 [8,8–10,6] vs. 8,8 m/s [8,3–9,3], respectivamente). La amplificación de la presión sistólica central y de la presión de pulso central fueron también superiores, aunque no de forma significativa, en el grupo de PE grave respecto al de PE no grave. Conclusión: Las mujeres que han tenido PE grave presentan parámetros de RA más acusados que los de aquellas en las que la PE no revistió especial gravedad. Debiera evaluarse la conveniencia de incluir de forma rutinaria entre las mujeres que han tenido PE la determinación del IAc y especialmente la VOPcf, como estrategia de evaluación del riesgo cardiovascular.http://www.sciencedirect.com/science/article/pii/S2013251423001773PreeclampsiaRigidez arterialVelocidad de onda de pulso carótida-femoralÍndice de aumento centralPresión de aumento central |
| spellingShingle | Lara Belmar Vega José Luis Pérez Canga Milagros Heras Vicario Emilio Rodrigo Calabia Juan Carlos Ruiz San Millán Laura Díaz López Luis Martín Penagos Gema Fernández Fresnedo Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness Nefrología (English Edition) Preeclampsia Rigidez arterial Velocidad de onda de pulso carótida-femoral Índice de aumento central Presión de aumento central |
| title | Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness |
| title_full | Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness |
| title_fullStr | Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness |
| title_full_unstemmed | Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness |
| title_short | Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness |
| title_sort | association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness |
| topic | Preeclampsia Rigidez arterial Velocidad de onda de pulso carótida-femoral Índice de aumento central Presión de aumento central |
| url | http://www.sciencedirect.com/science/article/pii/S2013251423001773 |
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