Pathophysiology of Preeclampsia-Induced Vascular Dysfunction and Implications for Subclinical Myocardial Damage and Heart Failure

Leslee J. Shaw, Krishna Patel, Anuradha Lala-Trindade, Helen Feltovich, Luciana Vieira, Amy Kontorovich, Cande Ananth, Viviany R. Taqueti, Lindsey Mitrani, Toni Stern, Chelsea DeBolt, Nathan Kase, R. Theodore Smith, Jagat Narula, Roxana Mehran, Angela Bianco, Deepak L. Bhatt, Joanne L. Stone

Research output: Contribution to journalReview articlepeer-review

Abstract

Tragically, preeclampsia is a leading cause of pregnancy-related complications and is linked to a heightened risk for morbid and fatal cardiovascular disease (CVD) outcomes. Although the mechanism connecting preeclampsia to CVD risk has yet to be fully elucidated, evidence suggests distinct pathways of early and late preeclampsia with shared CV risk factors but with profound differences in perinatal and postpartum risk to the mother and infant. In early preeclampsia, <34 weeks of gestation, systemic vascular dysfunction contributes to near-term subclinical myocardial damage. Hypertrophy and diastolic abnormalities persist postpartum and contribute to early onset heart failure (HF). This HF risk remains elevated decades later and contributes to premature death. Black women are at the highest risk of preeclampsia and HF. These findings support closer monitoring of women postpartum, especially for those with early and severe preeclampsia to control chronic hypertension and reduce the potentially preventable sequelae of heightened CVD and HF risk.

Original languageEnglish
Article number100980
JournalJACC: Advances
Volume3
Issue number6
DOIs
StatePublished - Jun 2024

Keywords

  • diastolic function
  • early preeclampsia
  • heart failure
  • pregnancy

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