140 Hypertensive disorders, in particular, preeclampsia, are the most common medical complications of preg- nancy, and along with thromboembolic disease they rep- resent the major cause of maternal and perinatal mor- bidity and death. 1, 2 Despite significant improvements in the clinical approach to patients with preeclampsia, 2 large gaps still remain in our knowledge about the degree of target organ damage. In particular the problem of car- diac involvement has been poorly and incompletely in- vestigated during the last 20 years, and much of the avail- able data on the changes in cardiac structure and function during pregnancy were obtained in studies of normotensive subjects. 3-7 Furthermore, most published data on cardiac involvement in pregnancy-related hyper- tensive disorders, particularly preeclampsia, have been characterized by major limitations. The cardiac evalua- tion of pregnant patients with hypertension has fre- quently been limited to the investigation of systolic func- tion in nonhomogeneous populations of subjects with differing prognostic profiles. 8-12 Finally, little information is available regarding the duration and extent of cardiac involvement post partum or the relationship between the changes in cardiac structure and function and the plasma levels of specific markers of cardiac overload. In particular many recent studies have demonstrated the role of natriuretic peptides, particularly atrial natri- uretic peptide (ANP) and brain natriuretic peptide (BNP), as potential noninvasive markers for early detec- tion of left ventricular abnormalities. 13, 14 The enhanced production of these peptides in the presence of alter- ations in left ventricular function and structure is now recognized, and interest is growing in potential diagnos- tic use, possibly extended to pregnant patients. Indeed, From the Department of Internal Medicine, a the Department of Obstetrics and Gynecology, b and the Department of Clinical Pharmacology, c Uni- versity of Bologna. Received for publication August 4, 1999; revised September 22, 1999; accepted January 13, 2000. Reprint requests: Claudio Borghi, MD, Divisione di Medicina Interna, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy. Copyright © 2000 by Mosby, Inc. 0002-9378/2000 $12.00 + 0 6/1/105684 doi:10.1067/mob.2000.105684 Relationship of systemic hemodynamics, left ventricular structure and function, and plasma natriuretic peptide concentrations during pregnancy complicated by preeclampsia Claudio Borghi, MD, a Daniela Degli Esposti, MD, a Vincenzo Immordino, MD, a Alberto Cassani, MD, b Stefano Boschi, MS, c Luciano Bovicelli, MD, b and Ettore Ambrosioni, MD a Bologna, Italy OBJECTIVE: This study was done to evaluate left ventricular structure and function among pregnant pa- tients with preeclampsia and compare them with those of normotensive pregnant and nonpregnant subjects. It also tested the hypothesis that abnormalities in left ventricular structure and function are associated with elevated plasma levels of natriuretic peptides. STUDY DESIGN: The study compared 75 pregnant women (n = 40 with preeclampsia; n = 35 normotensive pregnant women) and 10 nonpregnant normotensive control subjects undergoing an echocardiographic and biohumoral (renin activity and aldosterone, atrial natriuretic peptide, and brain natriuretic peptide concentra- tions) evaluation. The statistical analysis was carried out by analysis of variance, and significance was set at P < .05. RESULTS: Comparison of pregnant patients with preeclampsia versus both normotensive pregnant women and nonpregnant women showed significant increases in left ventricular mass and left ventricular end- systolic and end-diastolic volumes and significant reductions in left ventricular ejection fraction and percent- age of fractional shortening. These changes coincided with increases in plasma levels of atrial natriuretic peptide and brain natriuretic peptide that were linearly related to the left ventricular structural and functional changes observed in patients with preeclampsia. CONCLUSION: Pregnant patients with preeclampsia showed adaptation to the increase in systemic blood pressure, with significant modification of left ventricular structure and function related to the plasma levels of both atrial natriuretic peptide and brain natriuretic peptide. A simple evaluation of plasma natriuretic peptide concentrations could help to discriminate patients with preeclampsia who have a condition of mild left ven- tricular overload. (Am J Obstet Gynecol 2000;183:140-7.) Key words: Hypertension, left ventricular function, natriuretic peptides, preeclampsia