Relationship of systemic hemodynamics, left ventricular structure and function, and plasma natriuretic peptide concentrations during pregnancy complicated by preeclampsia

OBJECTIVE: This study was done to evaluate left ventricular structure and f unction among pregnant patients with preeclampsia and compare them with tho se of normotensive pregnant and nonpregnant subjects, It also tested the hy pothesis that abnormalities in left ventricular structure and function are associated with elevated plasma levels of natriuretic peptides. STUDY DESIGN: The study compared 75 pregnant women (n = 40 with preeclampsi a; n = 35 normotensive pregnant women) and 10 nonpregnant normotensive cont rol subjects undergoing an echocardiographic and biohumoral (renin activity and aldosterone, atrial natriuretic peptide, and brain natriuretic peptide concentrations) evaluation. The statistical analysis was carried out by an alysis of variance, and significance was set at P < .05. RESULTS: Comparison of pregnant patients with preeclampsia versus both norm otensive pregnant women and nonpregnant women showed significant increases in left ventricular mass and left ventricular end-systolic and end-diastoli c volumes and significant reductions in left ventricular ejection fraction and percentage of fractional shortening. These changes coincided with incre ases in plasma levels of atrial natriuretic peptide and brain natriuretic p eptide that were linearly related to the left ventricular structural and fu nctional changes observed in patients with preeclampsia. CONCLUSION: Pregnant patients with preeclampsia showed adaptation to the in crease in systemic blood pressure, with significant modification of left ve ntricular structure and function related to the plasma levels of both atria l natriuretic peptide and brain natriuretic peptide. A simple evaluation of plasma natriuretic peptide concentrations could help to discriminate patie nts with preeclampsia who have a condition of mild left ventricular overloa d.