Impact of preeclampsia on ventricular repolarization indices
Introduction
Preeclampsia which is characterized by hypertension and proteinuria remains the leading cause of maternal and fetal morbidity and mortality. Left untreated, this pathologic condition can lead to serious complications including, abruptio placentae, intrauterine growth restriction, premature delivery, and intrauterine fetal death [1,2]. Hemodynamic alterations associated with increased workload result in left ventricular remodeling in preeclamptic women. As a result of cardiac hypertrophy and electrophysiological alterations, worsening of preexisting arrhythmias or the occurrence of de novo arrhythmias are common in patients with preeclampsia [3,4]. In addition, changes in circulating hormones, electrolyte levels, and increased sympathetic neural outflow may alter ventricular repolarization dynamics in patients with preeclampsia [5,6]. Therefore, pregnancy with abnormal uterine perfusion is associated with changes in ventricular repolarization heterogeneity and adverse clinical outcomes [7].
Prolonged dispersion of myocardial repolarization is a reliable electrocardiographic indicator for ventricular arrhythmias and evaluated by various methods, such as QT interval (QT), heart rate, corrected QT interval (QTc), and QT dispersion [8]. In addition, the time interval from the peak to the end of the T wave (Tp-e interval) on electrocardiogram is considered a novel index of transmural dispersion of repolarization. Tp-e/QT and Tp-e/QTc ratios may also be a reliable index in terms of predicting ventricular tachyarrhythmias [9]. However, its importance in patients with preeclampsia has yet to be determined. In the present study, we aimed to assess the impact of preeclampsia on ventricular repolarization indices.
Section snippets
Study population
In this cross-sectional study, subjects were selected from the patients who were referred to our outpatient cardiology clinic between January 1 st, 2019, and January 1 st, 2020 due to newly diagnosed preeclampsia. All patients' past medical records and medications were scanned and underwent detailed ECG and echocardiographic assessment. Baseline clinical characteristics, laboratory values, maternal age, gravidity, and parity were evaluated by using our hospital database. In addition, all
Results
Over the period from January 2019 to January 2020, 60 eligible patients diagnosed with preeclampsia and 30 age-matched healthy pregnant women were included in this study. Clinical and laboratory findings are shown in Table 1. There were no significant differences between the groups in terms of age, parity, estimated BMI, and laboratory values (p > 0.05). However, the rate of SGA was significantly higher in patients with early-onset preeclampsia compared to patients with late-onset preeclampsia
Discussion
The main finding of our study is; women with early-onset preeclampsia had lower heart rate, longer P wave duration, QT and Tp-e intervals, and higher Tp-e/QT and Tp-e/QTc ratio compared to women with late-onset preeclampsia and healthy pregnant women. To the best of our knowledge, this is the first study in literature investigating Tp-e interval and Tp-e/QT, Tp-e/QTc ratio in patients with subtypes of preeclampsia.
In our study, the P wave duration, which reflects the size of the atria, was
Conclusion
In conclusion, preeclampsia has unfavorable effects on electrocardiographic indices of ventricular repolarization compared to healthy pregnant women. This effect is more prominent in women presenting with early-onset preeclampsia. Although previous studies showed conflicting results in terms of the association between QT interval and pregnancy-induced hypertensive disorders, measurement of Tp-e interval and Tp-e/QT, Tp-e/QTc on a standard 12‑lead ECG could be easily included in the clinical
Limitations
The main limitations of the present study include that it was a single-center experience with a relative small sample size. Thus, further prospective studies with a larger population are needed to confirm our results. Although we evaluated the relationship between preeclampsia and ventricular repolarization indices, we did not follow our patients regarding the development of malignant ventricular arrhythmias and sudden cardiac death. Due to exclusion of patients with a pre-pregnancy history of
Funding source
None.
Declaration of Competing Interest
The authors report no conflicts of interest.
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