Carotid-radial pulse wave velocity as an alternative tool for the evaluation of endothelial function during pregnancy: potential role in identifying hypertensive disorders of pregnancy

摘要

Preeclampsia/eclampsia syndrome, a major cause of maternal mortality and morbidity, has been recognized as a condition with a globally impaired endothelial function (EF). The possibility of identifying early subclinical endothelial damage during pregnancy could be of value in classifying the different hypertensive states of pregnancy, and have a positive impact in the understanding of this syndrome, as well as on the appropriate treatment of these patients. Reactive hyperemiarelated changes in carotid-radial pulse wave velocity (PWVcr) were proposed as an alternative tool for the evaluation of EF in patients with cardiovascular risk factors. If impaired EF, which follows hypertensive disorders of pregnancy can be assessed using PWVcr changes remains still unknown. Aims: To assess and compare reactive hyperemia-related changes in PWVcr and FMD in pregnant women (healthy and with hypertensive disorders) and non pregnant women. Methods: Healthy pregnant (HP; n=13), preeclamptic (PE; n=7), non-proteinuric hypertensive (NPH; n=6) and non-pregnant (NP; n=32) women were included. Left PWVcr (strain gauge mechanotransducers), left brachial arterial diameter (B-Mode ultrasound) and blood flow velocity (Doppler ultrasound) were measured before (baseline) and after the transient ischemia of the left forearm were determined. Results: One minute after the cuff deflation, PWVcr decreased in HP (6.9 ± 1.5 to 6.0 ± 0.9 m/s, p<0.001) and in NP (8.1 ± 0.9 to 7.4 ± 0.9 m/s; p<0.001). NPH showed a blunted hyperemic PWVcr response (6.6 ± 1.4 to 6.7 ± 1.0 m/s; p=0.91), whereas PE showed a tendency to increase (6.0 ± 0.7 to 6.4 ± 0.8 m/s; p=0.10). Reactive hyperemia PWVcr response (ΔPWVcr in %) differed comparing HP with NPH (-12% vs. +2%; p<0.01) and with PE (-12 vs. +6%; p <0.01), whereas no differences were found between NHP and PE (p=1.00). Conclusion: HP showed an enhanced PWVcr reduction, whereas PE and NPH showed a blunted hyperemic PWVcr response. Carotid-radial PWVcr analysis could have a potential role in the assessment of pregnancy to study EF with a potential clinical application in predicting pregnancy induced hypertension and preeclampsia.