The efficacy of peripartum transthoracic echocardiography in women with preeclampsia.

OBJECTIVE: To examine the features and efficacy of transthoracic echocardiography (TTE) in preeclampsia. METHODS: We retrospectively reviewed the medical records of 145 pregnant women with preeclampsia, who underwent TTE at Seoul St. Mary's Hospital between July 2006 and June 2016. We analyzed echocardiographic features in preeclampsia and the relationship between the severity of preeclampsia and TTE findings. Additionally, we examined the predictive echocardiographic factors of persistent hypertension and calculated the adjusted odds ratio (OR) and 95% confidence interval (CI) for multiple regression models by considering systolic and diastolic blood pressure and pre-pregnancy body mass index (BMI). RESULTS: Hemodynamic findings assessed by TTE in women with preeclampsia included systolic and diastolic dysfunction, increased left ventricular mass, and enlarged left atrium. Diastolic dysfunction and left ventricular hypertrophy (LVH) were more common in preeclampsia with severe features (39.84% vs. 32.05%, p=0.010, and 21.79% vs. 8.96%, p=0.041, respectively). In the patients with systolic dysfunction, the adjusted OR for persistent hypertension was 17.41 (95% CI=2.83-107.20). The ORs for grade 1 and grade 2 diastolic dysfunction were 12.58 and 32.84, respectively (95% CI, 2.99-52.92 and 3.61-298.58, respectively). When LVH assessed by TTE was considered with diastolic dysfunction, the risk for persistent hypertension increased (OR 19.28; 95% CI-4.36-85.20). CONCLUSION: TTE not only can reveal the severity of preeclampsia, but also can be a useful tool for the follow-up of persistent hypertension.

Proangiogenic features of Wharton's jelly-derived mesenchymal stromal/stem cells and their ability to form functional vessels.

Mesenchymal stromal/stem cells derived from human Wharton's jelly (WJ-MSC) have emerged as a favorable source for autologous and allogenic cell therapy. Here, we characterized the proangiogenic features of WJ-MSCs and examined their ability to form functional vessels in in vivo models. First, we examined whether WJ-MSCs express endothelial and smooth muscle cell specific markers after culture in endothelial growth media. WJ-MSCs expressed an endothelial specific marker, VEGFR1, at mRNA and protein levels, but did not express other specific markers (VEGFR2, Tie2, vWF, CD31, and VE-cadherin). Rather, WJ-MSCs expressed smooth muscle cell specific markers, α-SMA, PDGFR-ß and calponin, and were unable to form tube-like structures with lumen on Matrigel. WJ-MSCs secreted growth factors including angiogenin, IGFBP-3, MCP-1, and IL-8, which stimulated endothelial proliferation, migration, and tube formation. When WJ-MSCs suspended in Matrigel were implanted into nude mice, it led to formation of functional vessels containing erythrocytes after 7 days. However, implantation of endothelial cell-suspended Matrigel resulted in no perfused vessels. The implanted WJ-MSCs were stained positively for calponin or PDGFR-ß and were located adjacent to the lining of mouse endothelial cells that were stained with labeled BS-lectin B4. In a murine hindlimb ischemia model, the transplantation of MSCs (5×10(5)cells) into the ischemic limbs improved perfusion recovery and neovascularization of the limbs compared to control group. Therefore, the results suggest that WJ-MSCs promote neovascularization and perfusion by secreting paracrine factors and by functioning as perivascular precursor cells, and that WJ-MSCs can be used efficiently for cell therapy of ischemic disease.