Activin A and Late Postpartum Cardiac Dysfunction Among Women With Hypertensive Disorders of Pregnancy
| Autor: | Avery Tung, Roberto M. Lang, Hadi Ramadan, Lynn Weinert, Rabab Nasim, Ariel Mueller, Sireesha Chinthala, Vijal Patel, Sarosh Rana, Sajid Shahul, Junaid Nizamuddin, John C. Dreixler |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Heart Ventricles Pregnancy Trimester Third Blood Pressure Disease 030204 cardiovascular system & hematology Ventricular Function Left Preeclampsia Ventricular Dysfunction Left 03 medical and health sciences 0302 clinical medicine Pregnancy Internal Medicine medicine Humans Prospective Studies reproductive and urinary physiology 030219 obstetrics & reproductive medicine Obstetrics business.industry Postpartum Period Confounding Hypertension Pregnancy-Induced medicine.disease Activins Echocardiography Case-Control Studies Heart failure embryonic structures Cohort Gestation Biomarker (medicine) Female business Biomarkers |
| Zdroj: | Hypertension. 72:188-193 |
| ISSN: | 1524-4563 0194-911X |
| Popis: | Women with hypertensive disorders of pregnancy have an increased risk of subsequent heart failure and cardiovascular disease when compared with women with normotensive pregnancies. Although the mechanisms underlying these findings are unclear, elevated levels of the biomarker activin A are associated with myocardial dysfunction and may have predictive value. We hypothesized that elevated levels of antepartum activin A levels would correlate with postpartum cardiac dysfunction in women with hypertensive disorders of pregnancy. We prospectively studied 85 women to determine whether increased antepartum activin A levels were associated with cardiac dysfunction at 1 year postpartum as measured by global longitudinal strain. Thirty-two patients were diagnosed with preeclampsia, 28 were diagnosed with gestational or chronic hypertension, and the remainder were nonhypertensive controls. Activin A levels were measured with ELISA both in the third antepartum trimester and at 1 year postpartum. Comprehensive echocardiograms including measurement of global longitudinal strain were also performed at enrollment and at 1 year postpartum. Antepartum activin A levels correlated with worsening antepartum global longitudinal strain ( r =0.70; P =0.0001). Across the entire cohort, elevated antepartum activin A levels were associated with the development of abnormal global longitudinal strain at 1 year (C statistic 0.74; P =0.004). This association remained significant after multivariable adjustment for clinically relevant confounders (C statistic 0.93; P =0.01). Postpartum activin A levels also correlated with increasing left ventricular mass index ( P =0.02), increasing mean arterial pressures ( P =0.02), and decreasing E′ values ( P =0.01). Activin A may be a useful tool for identifying and monitoring patients at risk for postpartum development of cardiovascular disease. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|