A A Khalil1, D J Cooper, K F Harrington. 1. Department of Obstetrics and Gynaecology, Queen Mary, University of London, and King's College Hospital, London, UK. asmakhalil79@googlemail.com
Abstract
OBJECTIVE: To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia. DESIGN: This was a prospective screening study. SETTING: The Homerton University Hospital, a London teaching hospital. POPULATION: Two hundred and ten low-risk women with a singleton pregnancy were analysed. METHODS: Radial artery pulse waveforms were measured between the 11(+0) and 13(+6) weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve. MAIN OUTCOME MEASURES: Prediction of pre-eclampsia by AIx-75. RESULTS: Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia. CONCLUSION: First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening.
OBJECTIVE: To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia. DESIGN: This was a prospective screening study. SETTING: The Homerton University Hospital, a London teaching hospital. POPULATION: Two hundred and ten low-risk women with a singleton pregnancy were analysed. METHODS: Radial artery pulse waveforms were measured between the 11(+0) and 13(+6) weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve. MAIN OUTCOME MEASURES: Prediction of pre-eclampsia by AIx-75. RESULTS: Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia. CONCLUSION: First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening.
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