Inappropriate left ventricular mass after HELLP syndrome inappropriate LVM after HELLP syndrome

• Published in: Pregnancy Hypertension Vol. 27; pp. 16 - 22
• Main Authors: Sciatti, Edoardo, Mohseni, Zenab, Orabona, Rossana, Mulder, Eva G, Prefumo, Federico, Lorusso, Roberto, Frusca, Tiziana, Spaanderman, Marc E A, Ghossein-Doha, Chahinda
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2022; Elsevier BV
• Subjects: AMERICAN SOCIETY; BLOOD-PRESSURE; CARDIOVASCULAR-DISEASE; Case-Control Studies; Cross-Sectional Studies; Echocardiography; Echocardiography; HELLP syndrome; Inappropriate left ventricular mass; Mechano-energetic efficiency; Pre-eclampsia; Remodeling; ELEVATED LIVER-ENZYMES; ENERGETIC EFFICIENCY; EUROPEAN ASSOCIATION; Female; HELLP Syndrome; HELLP Syndrome - epidemiology; Humans; HYPERTENSIVE SUBJECTS; Hypertrophy, Left Ventricular; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - epidemiology; Hypertrophy, Left Ventricular - etiology; Inappropriate left ventricular mass; Mechano-energetic efficiency; MYOCARDIAL OXYGEN-CONSUMPTION; Pre-Eclampsia; Pre-Eclampsia - epidemiology; Pregnancy; Remodeling; Risk Assessment; STROKE VOLUME; VASCULAR STIFFNESS; Ventricular Remodeling; Echocardiography; Pre-eclampsia; Remodeling; HELLP syndrome; Mechano-energetic efficiency; Inappropriate left ventricular mass
• ISSN: 2210-7789; 2210-7797; 2210-7797
• DOI: 10.1016/j.preghy.2021.11.003

•Pregnancy complicated by pre-eclampsia (PE) and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is associated with an increased risk of cardiovascular diseases later in life.•Inappropriate left ventricular mass (LVM) and mechano-energetic efficiency (MEE) can be easily analyzed by transthoracic echocardiography.•From 6 months to 4 years after delivery, LVM was inappropriate in one-third of normotensive former HELLP and in about one-half of PE with or without HELLP, with no difference among groups.•In the same timespan, MEE showed a tendency towards lower values in former pre-eclamptic individuals. Excessive left ventricular mass (LVM) results in inefficient LV work with energy waste leading to a negative prognostic effect. We aimed at investigating the presence of inappropriate LVM and calculating the myocardial mechano-energetic efficiency index (MEEi) in former pre-eclamptic (PE) women (with or without HELLP syndrome) compared to women who experienced HELLP syndrome without PE. In this cross-sectional study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent echocardiography as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity. LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was considered as the ratio between stroke work and “double product” (to approximate energy consumption), indexed to LVM. LV hypertrophy was present in 8–14% and concentric remodeling in 31–42% of women, without intergroup difference. LVM was inappropriate in one-third of normotensive former HELLP and in about one-half of PE with or without HELLP, with no difference among groups. Accordingly, without nominal difference, MEEi showed a tendency towards lower values in former pre-eclamptic individuals. Women with a history of HELLP syndrome, independently from the presence/absence of PE, showed inappropriate LVM in the first 4 years after delivery, which may partially explain the elevated CV risk in these women compared to the general female population.