Pre-eclampsia Paradigm: Analyzing Angiogenic Markers, Cardiac Biomarkers, and Maternal Myocardial Indices

Objectives: Pre-eclampsia (PE) is a pregnancy-specific hypertensive condition characterized by angiogenic imbalance, abnormal placentation, and elevated maternal cardiovascular stress. Placental dysfunction and disease severity are indicated by soluble fms-like tyrosine kinase-1 to placental growth factor ratio (sFlt-1/PLGF), while myocardial strain is specified by N-terminal pro-brain natriuretic peptide (NT-proBNP) and myocardial work. Conventional echocardiography may fail to identify early cardiac involvement in PE. Myocardial work indices resulting from left ventricular pressure–strain loops provide load-adjusted assessment of myocardial performance and enable detection of subclinical myocardial dysfunction. The integration of angiogenic and cardiac biomarkers, myocardial work indices in prediction, and maternal and fetal outcomes needs to be assessed. The objective of the study is to evaluate the correlation “between angiogenic marker (sFlt-1/PLGF ratio), cardiac biomarker (NTproBNP), and myocardial work indices in women with PE and to assess their relationship with adverse maternal and neonatal” outcomes. Materials and Methods: It was a prospective cohort study conducted in a tertiary care center from May 1, 2025, to July 31, 2025. A total of 120 pregnant women from 20 to 37 weeks were enrolled. They were divided into two groups of 60 each: Group A: women with PE; Group B: normotensive women. The serum sFlt-1/PLGF ratio and NT-proBNP levels have all been determined through ECLIA on the cobas analyzer (Roche Diagnostics). Global work index (GWI), global work efficiency (GWE), global constructive work (GCW), global wasted work (GWW), utilizing non-invasive pressure-strain loop analysis, and comprehensive transthoracic echocardiography were calculated. Maternal and neonatal outcomes were noted until delivery. A cohort-specific sFlt-1/PLGF cutoff of 102 was identified using receiver operating characteristic analysis. Statistical analysis encompassing Spearman correlation, Chi-square test, Mann–Whitney U test, receiver operating characteristic (ROC) analysis, exhibiting P < 0.05, is regarded as significant. Results: Women with PE demonstrated statistically significant values of sFlt-1/PLGF ratios, NT-proBNP concentrations, and spot protein–creatinine ratios compared with normotensive women ( P < 0.001). Left ventricular ejection fraction was preserved in both groups. GWE was decreased while GWI, GCW, and GWW were all elevated, indicating a significant change in all myocardial work indices ( P = 0.001). GWE demonstrated a significant inverse correlation with sFlt-1/PLGF ratio. Higher sFlt-1/PLGF ratios were related to a shorter interval to delivery, with a median delivery interval of approximately 4 weeks. ROC analysis demonstrated the highest sensitivity of global wasted work. Women with PE had more frequent adverse maternal and neonatal outcomes. Conclusion: PE is associated with marked angiogenic imbalance, elevated NT-proBNP levels, and impaired myocardial work, reflecting early cardiovascular involvement despite preserved systolic function. Combined assessment of angiogenic biomarkers, cardiac biomarkers, and myocardial work indices provides complementary information for risk stratification and long-term cardiovascular diseases in PE.