Cardiac Dysfunction and Remodeling in Patients With Preeclampsia

Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau440 enrolled

Overview

Preeclampsia (PE) is a pregnancy-related hypertensive disorder drive by an anti-angiogenic environment. Women with PE have 2-4 time higher risk of developing cardiovascular disease (CVD), although the specific mechanism relating these two conditions remains elusive. In non-pregnant patients with coronary disease, angiogenic profile proved to be an independent predictor of poor prognosis and is associated with a higher mortality rate. The investigators hypothesized that in PE, the antiangiogenic environment determines the degree of cardiac dysfunction and remodeling and the posterior cardiovascular risk.

Main objective: To determinie the relationship between antiangiogenic environment and cardioc dysfuntion and remodelin in women at risk and in established PE. M\&M: placental dysfunction markers (angiogenic factors (PlGF) and anti-angiogenic factor (sFlt1) and cardiovascular risk variables (BMI, BP, arterial stiffness, copectin, proBNP, high-sensitivity troponin, carotid intima thickness and echocardiography parameters) would be evaluated in 280 patients at risk of PE according to first trimester screening and 100 controls. Additionally, cardiac dysfunction parameters would be evaluated in women with established PE (n=60) and common transcriptomic signatures between cardiovascular disease and preeclampsia would be investigated in placental samples from 10 PE and 10 controls. It will provide evidences to evaluate and characterize the association between angiogenic factors and cardiac dysfunction and remodeling in PE.

Study Type

OBSERVATIONAL

Enrollment

440

Conditions

Preeclampsia Cardiovascular Risk Factor Pregnancy Complications

Interventions

Ecocardiographyc ultrasoundDIAGNOSTIC_TEST

* Epidemiological data: Maternal history risk factors. First trimester scan is performed on all patients. * Antropomethric measures * Systemic arterial stiffness: using applanation tonometry with pulse wave analysis and pulse wave velocity. * Carotid Intima Thickness * Echocardiography assessment: It will be performed by a cardiologist specialized in cardiac imaging according to the usual standard protocol. High resolution images will be acquired and post-processed with dedicated software for the speckle tracking analysis. 2D echocardiography parameters to be acquired, tissue Doppler and speckle tracking software * Markers in maternal blood: Angiogenic factor and cardiac function biomarkers: Blood samples will be collected without anticoagulant to obtain serum. sFLT-1, PlGF, High-sensitivity Troponin and NT-proBNP will be measured using automated electrochemiluminescence immunoassays.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 45 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: 1. \>18 and \<45 years old. 2. Able to understand the study requirements. 3. Singleton pregnancy. 4. Accept of written informed consent. Exclusion Criteria: 1. \<18 or \>45 years old. 2. Not able to understand the study requirements. 3. Multiple pregnancy. 4. Previous conditions: abnormal thrombophilia, alcohol or illicit drug use, type-1 diabetes, hyperthyroidism, renal disease, severe maternal illness, cytomegalovirus or toxoplasma infection, maternal HIV infection, , previous venous or arterial thrombotic event, and 5. known major fetal anomaly or chromosomal abnormality at inclusion 6. denial of written informed consent.

Outcomes

Primary Outcomes

To prospectively assess both biochemical and biophysical markers of cardiovascular dysfunction in a cohort of patients with a risk of pe and in healthy pregnant women in the fisrt and third trimester of pregnancy.

\- Cardiac dysfunction/remodeling in the first and third trimester of pregnancy and in 12 moths after delivery as defined by: 1. abnormal cardiac performace in the ecocardiographyc ultrasound assessment or/and 2. abnormal biochemical cardiac markers (copectin, proBNP, high-sensitivity troponin)

Time frame: 12 months

Secondary Outcomes

To determine the correlation among antiogenic (PlGF) and anti-angiogenic factors (sFlt1) in maternal serum and biochemical and imaging markers of cardiac dysfunction and remodeling in patients with established PE AND

Venous blood will be drawn, with informed consent, from the cubital vein without a tourniquet and using a 20-G needle into Vacutainer CPT

Time frame: 9 months