Associação entre dilatação mediada por fluxo da artéria braquial e morbidade por pré-eclâmpsia

Abstract

Objectives: to evaluate the association between brachial artery Flow Mediated Dilatation (FMD) and preeclampsia morbidity. Methods: Sixty-four pregnant women at the diagnosis of preeclampsia were selected. FMD and routine preeclampsia markers were assessed at enrollment and followed until delivery. Women were grouped and compared according to their outcomes (26 developed complications and 38 did not). Results: Median FMD is impaired in women with complicated preeclampsia (7.44%; IQR 2.20-13.34%) compared to those without complications (11.80%; IQR 5.36-16.66%) (p=0,03). The cutoff value of FMD ≤4.5% was associated with approximately four-fold odds increment of any complication (OR 3.79; IC95% 1.23-11.70), similar to the protein to creatinine ratio >2,0 (OR 4.50; IC95% 1.21-16.74). Systolic and diastolic blood pressure were not associated with risk for complication and uric acid had a borderline significance (OR 3.38; IC95% 0,98-11,72). Moreover, when major complications (eclampsia, HELLP syndrome or stillbirth) were selected as a composite outcome FMD was even lower (2.84%; IQR 0.00 7.22%) and FMD ≤4.5% was associated with a marked 15 fold increased risk for these specific events (OR 15.55; IC95% 3.55-68.16). Although FMD seems to have a weak accuracy to predict any preeclampsia complications (AUC=0.66; IC95% 0.52-0.79), ROC curve analysis showed that it may be a prognostic marker for major complications (AUC=0.84; IC95% 0.73-0.96). Conclusion: FMD is associated with morbidity of preeclampsia, markedly in women with eclampsia, HELLP syndrome or stillbirth. FMD at preeclampsia diagnostic moment may be used as a prognostic marker of these poor outcomes.