Evaluation of cardiovascular function in women with a history of pre-eclampsia: A systematic review and meta-analysis.

Abstract

Introduction: Women with a history of pre-eclampsia are at increased risk of lifelong cardiovascular morbidity and mortality. However, the underlying mechanisms of disease association, and the ideal method of monitoring this high-risk group remains unclear. The aim of this study is to determine whether women with a history of pre-eclampsia show clinical or subclinical cardiovascular changes when evaluated by echocardiography. Method(s): A systematic search of MEDLINE, EMBASE and CINAHL databases was performed to identify studies that examined cardiovascular function in women with a history of pre-eclampsia, in comparison to those with a history of normotensive pregnancies. Result(s): In the 27 included studies, there was significant heterogeneity in the outcome measures and varying quality between studies. We found no statistically significant differences between exposed and non-exposed women with regard to left ventricular ejection fraction, isovolumetric relaxation time or deceleration time. Women with a history of pre-eclampsia demonstrated a higher left ventricular mass index and relative wall thickness with a mean difference of 4.25 g/m2 (95%CI 2.08,6.42) and 0.03 (95%CI 0.01, 0.05), respectively. In comparison to the non-exposed population they also demonstrated a lower E/A and a higher E/e' ratio with a mean difference of-0.08 (95%CI-0.15,-0.01) and 0.84 (95%CI 0.41, 1.27), respectively. Discussion(s): In comparison to women with a normotensive pregnancy, women with a history of pre-eclampsia demonstrate a trend towards altered cardiac structure and function. Further studies with larger sample sizes, and consistent echocardiograph reporting are required to assess the role of echocardiography in monitoring this high-risk group.