Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Weber, T.
Preeclampsia – monitoring of hemodynamic parameter and vasoactive substances (ADMA, SDMA and Endothelin-1)
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2015. pp.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Lackner Helmut Karl
- Rössler Andreas
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- Abstract:
- Preeclampsia is a multifactorial disease with a widely unknown pathophysiological process. The changed autonomic cardiovascular control as well as an impaired Baroreflex sensitivity contribute its part to a dysfunctional regulation of the blood pressure. Finally, the inhibition of nitric monoxide (NO) in preeclamptic women is taken into account to influence the pathophysiological process. 72 women were included in the study. They were divided according to their week of gestation and separated into preeclamptic women (16) and healthy controls (56). The week of pregnancy 33+6 is defined as early-onset preeclampsia, the week of pregnancy 34+0 is late-onset preeclampsia. The Task Force® Monitor (TFM®; CNSystems, Graz, Austria) was used to perform continuous hemodynamic monitoring of blood pressure, heart rate and thoracic impedance. The continuous blood pressure was derived non-invasively from the finger. The heart rate variability was be derived from a three-lead ECG. SDNN, rMSSD, LF, HF and the LF/HF-quotient were calculated and used for further descriptions. The baroreflex sensitivity was calculated with a rise/fall of the systolic blood pressure in addition to an increase/decrease of the R-R-interval. The pulse transit time was indexed by the time elapsed between the closest previous ECG R-wave and the steepest upstroke of the peripheral pulse at the finger. Finally, ADMA, SDMA and Endothelin-1 were determined using the ELISA-Kit. Age and height showed no significant difference between healthy and preeclamptic women. The weight difference (initial weight before pregnancy until after delivery) was higher in preeclampsia. The average day of birth was earlier in preeclamptic women than in healthy controls with 248 days and 274 days, respectively. The blood pressure (BP) showed higher values in preeclamptic women (systolic BP, diastolic BP and mean arterial blood pressure). The heart rate was almost steady in the control group, but decreased in preeclamtic women (p<0.05) with 87.7±13.2 beats per minute in early-onset preeclampsia and 73.9±12.8 beats per minute in late-onset preeclampsia. The breathing rate was constant in all groups. Concerning the heart rate variability, SDNN displayed a significant interaction (p<0.05) between early- and late onset PE versus healthy controls. rMSSD showed a significant finding between the groups regarding the gestational age (p<0.05), and also a significant interaction (p<0.01). The low frequency domains suggested no significant values, the high frequency domains displayed a significant interaction between healthy controls and preeclampsia (p<0.05). No significant result was shown in the LF/HF-quotient. The pulse transit time (PTT) showed that preeclamptic women have a significant lower PTT than the control group (p<0.05). The baroreflex sensitivity displayed a significant interaction between PE/control and the week of pregnancy (p<0.05). ADMA and SDMA showed higher levels in preeclamptic women (p<0.001) than in the control group. Endothelin-1 displayed no significant findings. Finally, we investigated in the correlation of the mean arterial blood pressure and ADMA with a correlation coefficient of 0.485, suggesting a positive correlation. The influence of the autonomic nervous system on the cardiovascular system seems to be impaired. The lower heart rate in late-onset preeclampsia might be due to a higher parasympathetic influence. SDNN, rMSSD and high frequency domains suggest that the parasympathetic nervous system is upregulated. The changed baroreflex sensitivity in late-onset PE gives evidence that the cardiovascular system of the expectant mother tries to adapt to the high blood pressure. Elevated ADMA and SDMA levels in preeclampsia show that endovascular inhibition of NO plays a role in the development of PE.