孕 24 周时高危血压正常孕妇的左心室中壁力学：与胎盘相关妊娠并发症的关系。

Left ventricular midwall mechanics at 24 weeks' gestation in high-risk normotensive pregnant women: relationship to placenta-related complications of pregnancy.

机构信息

Department of Cardiology, San Sebastiano Martire Hospital Frascati, Rome, Italy.

出版信息

Ultrasound Obstet Gynecol. 2012 Apr;39(4):430-7. doi: 10.1002/uog.10089. Epub 2012 Mar 12.

DOI:10.1002/uog.10089

PMID:22411543

Abstract

OBJECTIVES

Most studies during pregnancy have assessed maternal left ventricular (LV) function by load-dependent indices, assessing only chamber function. The aim of this study was to assess afterload-adjusted LV myocardial and chamber systolic function at 24 weeks' gestation and 6 months postpartum in high-risk normotensive pregnant women.

METHODS

A group of 118 high-risk women with bilateral notching of the uterine arteries underwent an echocardiographic examination to evaluate midwall mechanics (midwall shortening (mFS%) and stress-corrected midwall shortening (SCmFS%)) of the LV at 24 weeks' gestation and 6 months postpartum. Patients were followed until delivery and pregnancies were classified retrospectively as uneventful (uncomplicated outcome) or complicated. A control group of 54 low-risk women with uneventful pregnancies without bilateral notching was also enrolled.

RESULTS

The pregnancy was uneventful in 74 (62.7%) women, whereas 44 (37.3%) developed complications. At 24 weeks' gestation, mFS% and SCmFS% were greater in the uncomplicated-outcome compared with the complicated-outcome group (25.9 ± 4.8 vs 18.8 ± 5.0%, P < 0.001 and 107.9 ± 18.4 vs 77.9 ± 20.7%, P < 0.001, respectively). At 6 months postpartum, SCmFS% remained greater in the uncomplicated-outcome compared with the complicated-outcome group (100.4 ± 21.6 vs 87.8 ± 19.1, P < 0.05). In the uncomplicated-outcome group, SCmFS% was higher during pregnancy than it was postpartum, whereas in the complicated-outcome group, it was lower during pregnancy than it was postpartum (P < 0.05).

CONCLUSIONS

Maternal cardiac midwall mechanics appear to be enhanced (SCmFS% increased compared with controls) during pregnancy compared with postpartum in high-risk patients with uncomplicated pregnancy, whereas midwall mechanics are depressed both during pregnancy and postpartum in patients with pregnancy complications.

摘要

目的

大多数关于妊娠的研究都是通过负荷依赖性指标评估母体左心室（LV）功能，仅评估心室功能。本研究的目的是评估高危正常妊娠妇女在 24 孕周和产后 6 个月时的左心室后负荷调整心肌和腔室收缩功能。

方法

一组 118 例双侧子宫动脉出现切迹的高危孕妇接受了超声心动图检查，以评估 24 孕周和产后 6 个月时左心室的中层壁力学（中层缩短率（mFS%）和校正后的中层缩短率（SCmFS%））。患者一直随访到分娩，妊娠结果回顾性分为无并发症（无并发症）或有并发症。还招募了 54 例无并发症的低危正常妊娠孕妇作为对照组。

结果

74 例（62.7%）孕妇妊娠无并发症，44 例（37.3%）出现并发症。在 24 孕周时，无并发症组的 mFS%和 SCmFS%均高于有并发症组（25.9 ± 4.8 比 18.8 ± 5.0%，P < 0.001 和 107.9 ± 18.4 比 77.9 ± 20.7%，P < 0.001）。产后 6 个月时，无并发症组的 SCmFS%仍高于有并发症组（100.4 ± 21.6 比 87.8 ± 19.1，P < 0.05）。在无并发症组中，SCmFS%在妊娠期间高于产后，而在有并发症组中，SCmFS%在妊娠期间低于产后（P < 0.05）。