Department of Obstetrics and Gynecology, Fetal Maternal Medicine Unit, St Georges Hospital, University of London, London, UK.
Curr Opin Obstet Gynecol. 2011 Dec;23(6):440-7. doi: 10.1097/GCO.0b013e32834cb7a4.
Acute cardiovascular complications affect 6% of severe preeclampsia and epidemiological studies demonstrate a strong association between preeclampsia and subsequent cardiovascular morbidity and mortality. This data suggests that not only can preeclampsia acutely impair cardiac function, but also it has the potential to provoke myocardial ischaemia and affect long-term cardiovascular health. This review highlights the recent insights on cardiovascular impairment in preeclampsia and postpartum.
Recent studies on preeclampsia have used newer echocardiographic indices that are more sensitive at detecting asymptomatic myocardial damage, better correlated to invasive indices of myocardial function and are predictive for subsequent cardiovascular morbidity. Current findings indicate an unexpectedly high prevalence of cardiac impairment in preeclampsia and postpartum. These findings have important implications for the long-term cardiovascular health of women whose pregnancies were complicated by preeclampsia.
Preeclampsia is associated with stage B heart failure (asymptomatic left ventricular dysfunction/hypertrophy), a high prevalence of essential hypertension and an increased cardiovascular risk status within few years postpartum. These findings are more prevalent with early onset/preterm preeclampsia. These cardiovascular findings are consistent with epidemiological studies showing a 'dose-dependent' relationship between preeclampsia and long-term cardiovascular morbidity and mortality. There is increasing evidence supporting the concept that a history of early onset/preterm preeclampsia should be taken into account to identify women at high cardiovascular risk even in the absence of other concomitant risk factors.
严重先兆子痫患者中有 6%会发生急性心血管并发症，流行病学研究表明先兆子痫与随后的心血管发病率和死亡率之间存在很强的关联。这些数据表明，先兆子痫不仅会急性损害心脏功能，而且还有可能引发心肌缺血并影响长期心血管健康。本综述重点介绍了先兆子痫和产后心血管损害的最新研究进展。
最近对先兆子痫的研究使用了更新的超声心动图指标，这些指标在检测无症状心肌损伤方面更敏感，与心肌功能的有创指标相关性更好，并且可以预测随后的心血管发病率。目前的研究结果表明，先兆子痫和产后的心脏损伤发生率出乎意料地高。这些发现对因先兆子痫而怀孕的妇女的长期心血管健康具有重要意义。
先兆子痫与 B 期心力衰竭（无症状左心室功能障碍/肥大）、高血压患病率高以及产后几年内心血管风险状况增加有关。这些发现在前驱期/早产先兆子痫中更为常见。这些心血管发现与流行病学研究一致，表明先兆子痫与长期心血管发病率和死亡率之间存在“剂量依赖性”关系。越来越多的证据支持这样一种观点，即即使没有其他并存的危险因素，也应该考虑到早期/早产先兆子痫的病史，以识别心血管风险高的妇女。
