S S M Chen1, L Leeton2, J M Castro3, A T Dennis4. 1. Department of Cardiology, The Northern Hospital, Epping, Victoria, Australia; Department of Anaesthesia, The Royal Women's Hospital, Locked Bag 300, Corner Flemington Rd & Grattan St, Parkville, Victoria 3052, Australia. 2. Department of Anaesthesia, The Royal Women's Hospital, Locked Bag 300, Corner Flemington Rd & Grattan St, Parkville, Victoria 3052, Australia. 3. Department of Cardiology, St Vincent's Hospital, Fitzroy, Victoria, Australia. 4. Department of Anaesthesia, The Royal Women's Hospital, Locked Bag 300, Corner Flemington Rd & Grattan St, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynaecology; Department of Pharmacology and Melbourne Medical School (Anaesthesia, Perioperative and Pain Medicine Unit), Victoria, Australia. Electronic address: alicia.dennis@thewomens.org.au.
Abstract
BACKGROUND: Pre-eclampsia is characterised by increased left ventricular wall thickness on transthoracic echocardiography (TTE). This is assumed to be myocardial hypertrophy, however TTE cannot determine myocardial structure which may be muscle, oedema or fibrosis. Given the high incidence of peripheral oedema in pre-eclampsia, we hypothesised that increased thickness could represent oedema. Cardiovascular magnetic resonance (CMR) characterises myocardial tissue, differentiating between hypertrophy, oedema and fibrosis. This pilot study was designed to characterise myocardial composition using CMR in pregnant women (healthy or with pre-eclampsia) and to compare cardiac output and left ventricular mass using TTE and CMR. METHODS: Thirty-six women (31 healthy, five with pre-eclampsia) underwent TTE and CMR and left ventricular mass was assessed applying standard definitions. Myocardial signal intensities were measured from left ventricular segments and compared to serratus anterior muscle to determine global myocardial signal intensity. Myocardial oedema was defined as a myocardial:skeletal signal intensity ratio >1.9. Agreement between devices for cardiac output and left ventricular mass, and inter- and intra-observer measurements used Bland Altman methodology, calculating the agreement tolerable interval: >1.5 is unacceptable, 1.0-1.5 is marginal and <1.0 is acceptable agreement. RESULTS: Myocardial oedema was present in two (40%) pre-eclamptic women but no healthy women (P=0.017). Agreement for cardiac output was acceptable, for left ventricular mass marginal, and for inter- and intra-observer measurements acceptable. CONCLUSIONS: Cardiovascular magnetic resonance was used to characterise the myocardial tissue in women with pre-eclampsia. Data suggest that some women with pre-eclampsia have myocardial oedema rather than hypertrophy.
BACKGROUND: Pre-eclampsia is characterised by increased left ventricular wall thickness on transthoracic echocardiography (TTE). This is assumed to be myocardial hypertrophy, however TTE cannot determine myocardial structure which may be muscle, oedema or fibrosis. Given the high incidence of peripheral oedema in pre-eclampsia, we hypothesised that increased thickness could represent oedema. Cardiovascular magnetic resonance (CMR) characterises myocardial tissue, differentiating between hypertrophy, oedema and fibrosis. This pilot study was designed to characterise myocardial composition using CMR in pregnant women (healthy or with pre-eclampsia) and to compare cardiac output and left ventricular mass using TTE and CMR. METHODS: Thirty-six women (31 healthy, five with pre-eclampsia) underwent TTE and CMR and left ventricular mass was assessed applying standard definitions. Myocardial signal intensities were measured from left ventricular segments and compared to serratus anterior muscle to determine global myocardial signal intensity. Myocardial oedema was defined as a myocardial:skeletal signal intensity ratio >1.9. Agreement between devices for cardiac output and left ventricular mass, and inter- and intra-observer measurements used Bland Altman methodology, calculating the agreement tolerable interval: >1.5 is unacceptable, 1.0-1.5 is marginal and <1.0 is acceptable agreement. RESULTS:Myocardial oedema was present in two (40%) pre-eclamptic women but no healthy women (P=0.017). Agreement for cardiac output was acceptable, for left ventricular mass marginal, and for inter- and intra-observer measurements acceptable. CONCLUSIONS: Cardiovascular magnetic resonance was used to characterise the myocardial tissue in women with pre-eclampsia. Data suggest that some women with pre-eclampsia have myocardial oedema rather than hypertrophy.