Long-Term Postpartum Cardiac Function and Its Association With Preeclampsia

• Published in: Journal of the American Heart Association 2021-03, Vol.10 (5), p.e018526-e018526
• Main Authors: deMartelly, Victoria A, Dreixler, John, Tung, Avery, Mueller, Ariel, Heimberger, Sarah, Fazal, Abid A, Naseem, Heba, Lang, Roberto, Kruse, Eric, Yamat, Megan, Granger, Joey P, Bakrania, Bhavisha A, Rodriguez-Kovacs, Javier, Rana, Sarosh, Shahul, Sajid
• Format: Article
• Language: English
• Subjects: cardiac dysfunction; global longitudinal strain; Go Red for Women Spotlight; hypertension; preeclampsia/pregnancy; pregnancy and postpartum
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.120.018526

Background Preeclampsia is a prominent risk factor for long-term development of cardiovascular disease. Although existing studies report a strong correlation between preeclampsia and heart failure, the underlying mechanisms are poorly understood. One possibility is the glycoprotein growth factor activin A. During pregnancy, elevated activin A levels are associated with impaired cardiac global longitudinal strain at 1 year, but whether these changes persist beyond 1 year is not known. We hypothesized that activin A levels would remain increased more than 1 year after a preeclamptic pregnancy and correlate with impaired cardiac function. Methods and Results To test our hypothesis, we performed echocardiograms and measured activin A levels in women approximately 10 years after an uncomplicated pregnancy (n=25) or a pregnancy complicated by preeclampsia (n=21). Compared with women with a previously normal pregnancy, women with preeclampsia had worse global longitudinal strain (-18.3% versus -21.3%, =0.001), left ventricular posterior wall thickness (0.91 mm versus 0.80 mm, =0.003), and interventricular septal thickness (0.96 mm versus 0.81 mm, =0.0002). Women with preeclampsia also had higher levels of activin A (0.52 versus 0.37 ng/mL, =0.02) and activin/follistatin-like 3 ratio (0.03 versus 0.02, =0.04). In a multivariable model, the relationship between activin A levels and worsening global longitudinal strain persisted after adjusting for age at enrollment, mean arterial pressure, race, and body mass index ( =0.003). Conclusions Our findings suggest that both activin A levels and global longitudinal strain are elevated 10 years after a pregnancy complicated by preeclampsia. Future studies are needed to better understand the relationship between preeclampsia, activin A, and long-term cardiac function.