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Wave intensity analysis of maternal arterial stiffness: augmentation index and pulse wave velocity in pregnancies complicated by diabetes or hypertension

  • Maternal-Fetal Medicine
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Abstract

Purpose

The aim of our study was to compare the maternal arterial stiffness in pregnant women with diabetic disease, hypertension and those with normal pregnancies.

Methods

A cross-sectional study was performed involving 65 pregnant women with diabetic disease (DD group), 26 pregnant women with hypertension (RR group) and 448 women with normal pregnancies (control group). The augmentation index (AIx) and the pulse wave velocity (PWV) of the right carotid artery were assessed using non-invasive sonographic wave intensity analysis. Furthermore, the reliability of the measurements was evaluated in 21 healthy women.

Results

Compared with the controls, the AIx and PWV were increased in the DD group [11.0 (interquartile range, IQR 7.3, 15.2) vs. 5.7 (IQR 2.4, 9.3), P < 0.001; 5.7 (IQR 5.1, 6.4) vs. 5.2 (IQR 4.6, 6.1), P = 0.001; respectively] and the RR group [9.3 (IQR 6.6, 11.5) vs. 5.7 (IQR 2.4, 9.3), P < 0.001; 7.1 (6.3, 7.9) vs. 5.2 (IQR 4.6, 6.1), P < 0.001; respectively]. The intraclass and interclass correlation coefficients were good to excellent for the AIx (ICC: 0.91, P < 0.001 and 0.74, P < 0.002; respectively) and PWV measurements (ICC: 0.71, P < 0.004 and 0.70, P < 0.005; respectively).

Conclusion

Pregnancies complicated by diabetic disease or hypertension are associated with increased maternal arterial stiffness. The importance of wave intensity analysis needs to be verified and larger studies are needed to establish both normal and cutoff values that may be relevant for clinical decisions.

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Abbreviations

AIx:

Augmentation index

PWV:

Pulse wave velocity

WI:

Wave intensity

IQR:

Interquartile range

ICC:

Intraclass correlation coefficient

GDM:

Gestational diabetes mellitus

BMI:

Body mass index

References

  1. Duley L (2009) The global impact of pre-eclampsia and eclampsia. Semin Perinatol 33:130–137

    Article  Google Scholar 

  2. World Health Organization (2011) WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. WHO, Geneva

    Google Scholar 

  3. Ahmed R, Dunford J, Mehran R, Robson S, Kunadian V (2014) Pre-eclampsia and future cardiovascular risk among women: a review. J Am Coll Cardiol 63:1815–1822

    Article  Google Scholar 

  4. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH (2014) Global estimates of the prevalence of hyperglycemia in pregnancy. Diabetes Res Clin Pract 103:176–185

    Article  CAS  Google Scholar 

  5. Willum-Hansen T, Staessen JA, Torp-Pedersen C et al (2006) Prognostic value of aortic pulse wave velocity as index of aterial stiffness in the general population. Circulation 113:664–670

    Article  Google Scholar 

  6. Thijs L, Den Hond E, Nawrot T, Staessen JA (2004) Prevalence, pathophysiology and treatment of isolated systolic hypertension in the elderly. Expert Rev Cardiovasc Ther 2:761–769

    Article  Google Scholar 

  7. Cecelja M, Chowienczyk O (2009) Dissociation of aortic pulse wave velocity with risk factors for cardiovascular disease other than hypertension: a systematic review. Hypertension 54:1328–1336

    Article  CAS  Google Scholar 

  8. Parker KH, Jones CJ (1990) Forward and backward running waves in the arteries: analysis using the method of characteristics. J Biomech Eng 112:322–326

    Article  CAS  Google Scholar 

  9. Niki K, Sugawara M, Chang D et al (2002) A new noninvasive measurement system for wave intensity: evaluation of carotid arterial wave intensity and reproducibility. Heart Vessels 17:12–21

    Article  Google Scholar 

  10. Larsson M, Bjällmark A, Lind B et al (2009) Wave intensity wall analysis: a novel noninvasive method to measure wave intensity. Heart Vessels 24:357–365

    Article  Google Scholar 

  11. Desai DK, Moodley J, Naidoo DP (2004) Echocardiographic assessment of cardiovascular hemodynamics in normal pregnancy. Obstet Gynecol 104:20–29

    Article  Google Scholar 

  12. Khalil A, Jauniaux E, Cooper D, Harrington K (2009) Pulse wave analysis in normal pregnancy: a prospective longitudinal study. PLoS ONE 4:e6134

    Article  Google Scholar 

  13. Oyama-Kato M, Ohmichi M, Takahashi K et al (2006) Change in pulse wave velocity throughout normal pregnancy and its value in predicting pregnancy-induced hypertension: a longitudinal study. Am J Obstet Gynecol 195:464–469

    Article  Google Scholar 

  14. Spasojevic M, Smith SA, Morris JM, Gallery ED (2005) Peripheral arterial pulse wave analysis in women with pre-eclampsia and gestational hypertension. BJOG 112:1475–1478

    Article  Google Scholar 

  15. Kaihura C, Savvidou MD, Anderson JM, McEnjery CM, Nocilaides KH (2009) Maternal arterial stiffness in pregnancies affected by preeclampsia. Am J Physiol Heart Circ Physiol 297:H759–H767

    Article  CAS  Google Scholar 

  16. Hausvater A, Giannone T, Sandoval YH et al (2012) The association between preeclampsia and arterial stiffness. J Hypertens 30:17–33

    Article  CAS  Google Scholar 

  17. Yuan LJ, Xue D, Duan YY et al (2013) Carotid arterial intima-media thickness and arterial stiffness in pre-eclampsia: analysis with a radiofrequency ultrasound technique. Ultrasound Obstet Gynecol 42:644–652

    Article  CAS  Google Scholar 

  18. Khalil AA, Cooper DJ, Harrington KF (2009) Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre-eclampsia. BJOG 116:268–277

    Article  CAS  Google Scholar 

  19. Carty DM, Neisius U, Rooney LK, Dominiczak AF, Delles C (2014) Pulse wave analysis for the prediction of preeclampsia. J Hum Hypertens 28:98–104

    Article  CAS  Google Scholar 

  20. Marozio L, Chiarle G, Filippini C et al (2019) Arterial stiffness in normal pregnancy at 11–13 weeks of gestations and risk of late-onset hypertensive disorders of pregnancy. J Hypertens 37:1018–1022

    Article  CAS  Google Scholar 

  21. Anderson JM, Savvidou MD, Kaihura C, McEnjery CM, Nicolaides KH (2009) Maternal arterial stiffness in pregnancies affected by Type 1 diabetes mellitus. Diabet Med 26:1135–1140

    Article  CAS  Google Scholar 

  22. Savvidou MD, Anderson JM, Kaihura C, Nicolaides KH (2010) Maternal arterial stiffness in pregnancies complicated by gestational and type 2 diabetes mellitus. Am J Obstet Gynecol 203:274.e1–7

    Article  Google Scholar 

  23. Heusinkveld MHG, Delhaas T, Lumens J et al (2019) Augmentation index is not a proxy for wave reflection magnitude: mechanistic analysis using a computational model. J Appl Physiol 127:491–500

    Article  CAS  Google Scholar 

  24. Yinon Y, Kingdom JC, Odutayo A et al (2010) Vascular dysfunction in women with a history of preeclampsia and intrauterine growth restriction. Circulation 122:1846–1853

    Article  CAS  Google Scholar 

  25. Milic NM, Milin-Lazovic J, Weissgerber TL et al (2017) Preclinical atherosclerosis at the time of pre-eclamptic pregnancy and up to 10 years postpartum: systematic review and meta-analysis. Ultrasound Obstet Gynecol 49:110–115

    Article  CAS  Google Scholar 

  26. Visentin S, Londero AP, Bellamio B et al (2016) Fetal endothelial remodeling in late-onset gestational hypertension. Am J Hypertens 29:273–279

    Article  CAS  Google Scholar 

  27. Miyashita S, Murotsuki J, Muromoto J et al (2015) Measurement of internal diameter changes and pulse wave velocity in fetal descending aorta using the ultrasonic phased-tracking method in normal and growth-restricted fetuses. Ultrasound Med Biol 41:1311–1319

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank everyone who voluntarily dedicated their time and effort.

Funding

Aloka Inc. contributed to the project by loaning a ProSound Alpha 6 ultrasound system. Investigators received no additional profit. A contract guaranteed scientific independence for the investigating institution, especially with regard to the publication of results. Collection and analysis of data remained solely with the investigating institution. The authors have no relation to the funding cooperation beyond the conduct of this study. The terms of this arrangement have been reviewed and approved by the University of Münster in accordance with its policy on objectivity in research.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany

    Kathrin Oelmeier de Murcia, U. Möllmann, C. Opitz, H. A. Köster, M. Möllers, K. Hammer, M. K. Falkenberg, W. Klockenbusch & R. Schmitz

  2. Department of Fetal Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany

    J. Steinhard

Authors
  1. Kathrin Oelmeier de Murcia
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  2. U. Möllmann
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  3. C. Opitz
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  4. H. A. Köster
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  5. M. Möllers
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  6. K. Hammer
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  7. M. K. Falkenberg
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  8. J. Steinhard
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  9. W. Klockenbusch
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  10. R. Schmitz
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Contributions

KOM data collection, data management, data analysis, manuscript writing. UM data collection, data management, data analysis, manuscript editing. CO data collection, manuscript editing. HAK manuscript editing. MM data collection, manuscript editing. KH data collection, manuscript editing. MKF data collection, manuscript editing. JS project development, manuscript editing. WK data collection, manuscript editing. RS project development, data collection, data analysis, manuscript revision.

Corresponding author

Correspondence to Kathrin Oelmeier de Murcia.

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de Murcia, K.O., Möllmann, U., Opitz, C. et al. Wave intensity analysis of maternal arterial stiffness: augmentation index and pulse wave velocity in pregnancies complicated by diabetes or hypertension. Arch Gynecol Obstet 301, 1199–1205 (2020). https://doi.org/10.1007/s00404-020-05517-2

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  • DOI: https://doi.org/10.1007/s00404-020-05517-2

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