Maternal cardiac function after HELLP syndrome: an echocardiography study

Area of Science:

• Cardiovascular physiology
• Maternal health
• Obstetric complications

Background:

• Previous pregnancy complications like pre-eclampsia (PE) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome can have long-term cardiovascular implications.
• Understanding the persistent hemodynamic changes in women with a history of these conditions is crucial for postpartum care and future pregnancy management.

Purpose of the Study:

• To evaluate maternal hemodynamics in asymptomatic women with a history of HELLP syndrome.
• To compare these hemodynamic findings with women who had previous PE and with healthy controls.

Main Methods:

• Echocardiography was performed on women with a history of PE (n=60), HELLP syndrome (n=49), and matched controls (n=60).
• Measurements included left ventricular (LV) dimensions, ejection fraction (LVEF), mass, right ventricular (RV) function (tricuspid annular plane systolic excursion, fractional area change), and diastolic filling parameters.
• Tissue Doppler imaging and myocardial performance index were also assessed for both ventricles.

Main Results:

• Significant LV concentric hypertrophy was observed only in women with previous HELLP syndrome (20.4%).
• Both HELLP and PE groups exhibited LV concentric remodeling, diastolic dysfunction, and reduced LVEF.
• RV variables were largely similar, except for slightly impaired fractional area change and E/E' ratio in the HELLP group compared to the PE group.

Conclusions:

• Shared echocardiographic features in women with previous PE and HELLP syndrome suggest a common underlying pathophysiology.
• HELLP syndrome appears to be associated with more pronounced cardiovascular remodeling in the short to medium term postpartum.
• These findings highlight the importance of long-term cardiovascular monitoring for women with a history of hypertensive disorders of pregnancy.