ANALYSIS OF HEART RATE AND BLOOD PRESSURE VARIABILITY IN PREGNANCY - New Method for the Prediction of Preeclampsia
H. Malberg, R. Bauernschmitt, T. Walther, A. Voss, Renaldo Faber, Holger Stepan, N. Wessel
2008
Abstract
Pre-eclampsia is a serious disorder with high morbidity and mortality occurring during pregnancy; 3%–5% of all pregnant women are affected. Although most pre-eclamptic patients show pathological uterine perfusion in the second trimester, this parameter has a positive predictive accuracy of only 30%, which makes it unsuitable for early, reliable prediction. The study is based on the hypothesis that alterations in cardiovascular regulatory behavior can be used to predict PE. Ninety-six pregnant women in whom Doppler investigation detected perfusion disorders of the uterine arteries were included in the study. Twentyfour of these pregnant women developed PE after the 30th week of gestation. During pregnancy, additional several non-invasive continuous blood pressure recordings were made over 30 min under resting conditions by means of a finger cuff. In the period between the 18th and 26th weeks of pregnancy, three special variability and baroreflex parameters were able to predict PE several weeks before clinical manifestation. Discriminant function analysis of these parameters was able to predict PE with a sensitivity and specificity of 87.5% and a positive predictive value of 70%. The combined clinical assessment of uterine perfusion and cardiovascular variability demonstrates the best current prediction several weeks before clinical manifestation of PE.
References
- Chien, P.F., Arnott, N., Gordon, A., Owen, P., Khan, K.S. 2000, How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview. Brit J Obstet Gynaecol 107:196-208.
- Benedetto, C., Valensise, H., Marozio, L., Giarola, M., Massobrio, M., Romanini, C. 1998, A two-stage screening test for pregnancy-induced hypertension and preeclampsia. Obstet Gynecol 92:1005-1011.
- La Rovere, M.T., Pinna, G.D., Hohnloser, S.H., Marcus, F.I., Mortasa, A., Nohora, R., Bigger, T., Camm, A.J., Schwartz, P.J. 2001, Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias. Circulation 103: 2072-2077.
- Walther, T., Wessel, N., Baumert, M., Stepan, H., Voss, A., Faber, R. 2005, Longitudinal analysis of heart rate variability in chronic hypertensive pregnancy. Hypertension Res 28:113-118.
- Hermida, R.C., Ayala, D.E., Mojon, A., Fernandez, J.R., Silva, I., Ucieda, R., Iglesias, M. 1998, Blood pressure excess for the early identification of gestational hypertension and preeclampsia. Hypertension 31:83-89.
- Faber, R., Baumert, M., Stepan, H., Wessel, N., Voss, A., Walther, T. 2004, Baroreflex sensitivity, heart rate and blood pressure variability in hypertensive pregnancy disorders. J Hum Hypertens 18:707-712.
- Walther, T., Wessel, N., Malberg, H., Voss, A., Stepan, H., Faber, R. 2006, A combined technique for predicting pre-eclampsia: concurrent measurement of uterine perfusion and analysis of heart rate and blood pressure variability. Journal of Hypertension 24:747-750.
- Kleiger, R.E., Miller, J.P., Bigger, T., Moss, A.J. 1987, Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 59:256-262.
- Lippman, N., Stein, K.M., Lerman, B.B. 1994, Comparison of methods for removal of ectopy in measurement of heart rate variability. Am J Physiol 267:H411-418.
- Wessel, N., Voss, A., Malberg, H., Ziemann, Ch., Voss, H.U., Schirdewan, A., Meyerfeld, U., Kurths, J. 2000 Nonlinear analysis of complex phenomena in cardiological data. Herzschr Elektrophys 11: 159-173 Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. 1996, Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 93:1043-1065.
- Voss, A., Kurths, J., Kleiner, H.J., Witt, A., Wessel, N., Saparin, P., Osterziel, K.J., Schurath, R., Dietz, R. 1996, The application of methods of non-linear dynamics for the improved and predictive recognition of patients threatened by sudden cardiac death. Cardiovasc Res 31:419-433.
- Voss, A., Hnatkova, K., Wessel, N., Kurths, J., Sander, A., Schirdewan, A., Camm, A.J., Malik, M. 1998, Multiparametric analysis of heart rate variability used for risk stratification among survivors of acute myocardial infarction. Pacing Clin Electrophysiol 21(1 Pt 2):186- 192.
- Akselrod, S., Gordon, D., Ubel, F.A., Shannon, D.C., Barger, A.C., Cohen, R.J. 1981, Power spectrum analysis of heart rate fluctuation: A quantitative probe of beat-to-beat cardiovascular control. Science 213:220-222.
- Malliani, A., Pagani, M., Lombardi, F., Cerutti, S. Cardiovascular neural regulation explored in the frequency domain. Circulation1991;84:482-92.
- Bigger Jr, J.T., Fleiss, J.L., Steinman, R.C., Rolnitzky, L.M., Kleiger, R.E., Rottman, J.N. 1992, Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation 85:164- 71.
- La Rovere, M.T., Bigger, J.T., Marcus, F.I., Mortara, A., Schwartz, P.J. 1998, Baroreflex sensitivity and heartrate variability in prediction of total cardiac mortality after myocardial infarction. atrami (autonomic tone and reflexes after myocardial infarction) investigators. Lancet 351(9101):478-484.
- Vanoli, E., Adamson, P.B. 1994, Baroreflex sensitivity: methods, mechanisms, and prognostic value. Pacing Clin Electrophysiol 17(3 Pt 2):434-445.
- Cohen, I.M., O'Connor, D.T., Preston, R.A., Stone, R.A. 1981, Long-term clonidine effects on autonomic function in essential hypertensive man. Eur J Clin Pharmacol 19(1):25-32.
- Di Rienzo, M., Bertinieri, G., Mancia, G., Pedotti, A. 1985, A new method for evaluating the baroreflex role by a joint pattern analysis of pulse interval and systolic blood pressure series. Med Biol Eng Comput 23(suppl I):313-314.
- Malberg, H., Wessel, N., Schirdewan, A., Hasart, A., Osterziel, K.J., Griessbach, G., Voss, A. 2002, Advanced analysis of the spontaneous baroreflex sensitivity using the Dual Sequence Method. Clinical Science 102: 465-473.
- Saul, J.P., Berger, R.D., Albrecht, P., Stein, S.P., Chen, M.H., Cohen, R.J. 1991, Transfer function analysis of the circulation: unique insights into cardiovascular regulation. Am J Physiol 261: H1231-H1245.
- Laude, D., Elghizi, J.L., Girard, A., Bellard, E., Bouhaddi, M., Castiglioni, P., Cerutti, C., Cividjan, A., Di Rienzo, M., Fortrat, J.O., Janssen, B., Karemaker, J.M., Lefthériotis, G., Parati, G., Persson, P.B., Porta, A., Quintin, L., Regnerd, J., Rüdiger, H., Stauss, H.M. 2004, Comparison of various techniques to estimate spontaneous baroreflex sensitivity (the EuroBaVar study). Am J Physiol Regul Integr Comp Physiol, 286: R226-231
Paper Citation
in Harvard Style
Malberg H., Bauernschmitt R., Walther T., Voss A., Faber R., Stepan H. and Wessel N. (2008). ANALYSIS OF HEART RATE AND BLOOD PRESSURE VARIABILITY IN PREGNANCY - New Method for the Prediction of Preeclampsia . In Proceedings of the First International Conference on Bio-inspired Systems and Signal Processing - Volume 1: BIOSIGNALS, (BIOSTEC 2008) ISBN 978-989-8111-18-0, pages 47-55. DOI: 10.5220/0001066400470055
in Bibtex Style
@conference{biosignals08,
author={H. Malberg and R. Bauernschmitt and T. Walther and A. Voss and Renaldo Faber and Holger Stepan and N. Wessel},
title={ANALYSIS OF HEART RATE AND BLOOD PRESSURE VARIABILITY IN PREGNANCY - New Method for the Prediction of Preeclampsia},
booktitle={Proceedings of the First International Conference on Bio-inspired Systems and Signal Processing - Volume 1: BIOSIGNALS, (BIOSTEC 2008)},
year={2008},
pages={47-55},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0001066400470055},
isbn={978-989-8111-18-0},
}
in EndNote Style
TY - CONF
JO - Proceedings of the First International Conference on Bio-inspired Systems and Signal Processing - Volume 1: BIOSIGNALS, (BIOSTEC 2008)
TI - ANALYSIS OF HEART RATE AND BLOOD PRESSURE VARIABILITY IN PREGNANCY - New Method for the Prediction of Preeclampsia
SN - 978-989-8111-18-0
AU - Malberg H.
AU - Bauernschmitt R.
AU - Walther T.
AU - Voss A.
AU - Faber R.
AU - Stepan H.
AU - Wessel N.
PY - 2008
SP - 47
EP - 55
DO - 10.5220/0001066400470055