Detection of early left ventricular dysfunction in patients with maternal placental syndrome using tissue Doppler and strain rate imaging.

BACKGROUND

Maternal placental syndromes (MPS) occur as a consequence of abnormal placental vessel formation and refer to hypertensive pregnancy disorders and related placental abnormalities. The aim of this study is to investigate early alterations in left ventricular function in patients with history of MPS using tissue Doppler and strain rate imaging.

METHODS

We enrolled 122 females who were 6 months after delivery. Group 1 included 72 patients who experienced MPS. Group 2 included 50 women with normal pregnancy as control.

RESULTS

There was no significant difference between both groups with regard to ejection fraction, deceleration time, isovolumetric relaxation time, or E/A ratio. Deterioration of left ventricular systolic and diastolic function was evident in the MPS group, by TDI parameters (significantly lower values of Sm 7.5 ± 1.2 vs. 9.1 ± 1.3, p < 0.001; Em 7.0 ± 0.8 vs. 10.0 ± 1.4, p = 0.02; and Em-to-Am ratio 0.84 ± 0.14 vs. 1.2 ± 0.18, p < 0.001). Systolic strain, peak systolic strain rate, and early and late diastolic strain rates were also significantly lower in patients who had MPS than in the control group (-18.7 ± 2.6 vs. -20.8 ± 1.5, p < 0.001; -0.92 ± 0.14 vs. -1.01 ± 0.23, p < 0.001; 1.05 ± 0.11 vs. 1.29 ± 0.24, p < 0.001; 1.8 ± 0.3 vs. 1.2 ± 0.4, p < 0.001, respectively) and in patients who had severe pre-eclampia than mild pre-eclampsia. Pre-eclamptic women who had preterm delivery showed significantly higher left diastolic dysfunction.

CONCLUSION

Left ventricular systolic and diastolic dysfunction occur in patients with history of MPS. These abnormalities are evident on tissue Doppler and strain imaging even in the absence of changes in ejection fraction or standard diastolic parameters.