Khan Sitara G, Melikian Narbeh, Mushemi-Blake Sitali, Dennes William, Jouhra Fadi, Monaghan Mark, Shah Ajay M
Department of Cardiology, King's College London British Heart Foundation Centre, London, United Kingdom.
Department of Cardiology, King's College Hospital, London, United Kingdom.
PLoS One. 2016 Feb 9;11(2):e0147074. doi: 10.1371/journal.pone.0147074. eCollection 2016.
Peripartum cardiomyopathy is a potentially life-threatening cause of heart failure, commoner in Afro-Caribbean than Caucasian women. Its diagnosis can be challenging due to physiological changes in cardiac function that also occur in healthy women during the early postpartum period. This study aimed to (i) establish the overlap between normal cardiac physiology in the immediate postpartum period and pathological changes in peripartum cardiomyopathy ii) identify any ethnicity-specific changes in cardiac function and cardiac biomarkers in healthy postpartum women.
We conducted a cross-sectional study of 58 healthy postpartum women within 48 hours of delivery and 18 matched non-pregnant controls. Participants underwent cardiac assessment by echocardiography and strain analysis, including 3D echocardiography in 40 postpartum women. Results were compared with 12 retrospectively studied peripartum cardiomyopathy patients. Healthy postpartum women had significantly higher left ventricular volumes and mass, and lower ejection fraction and global longitudinal strain than non-pregnant controls. These parameters were significantly more impaired in peripartum cardiomyopathy patients but with overlapping ranges of values. Healthy postpartum women had higher levels of adrenomedullin, placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt1) compared to controls. The postpartum state, adrenomedullin, sFlt1 and the sFlt1:PlGF ratio were independent predictors of LV remodelling and function in healthy postpartum women.
Healthy postpartum women demonstrate several echocardiographic indicators of left ventricular remodelling and reduced function, which are associated with altered levels of angiogenic and cardiac biomarkers.
围产期心肌病是心力衰竭的一个潜在威胁生命的病因，在非洲加勒比裔女性中比白种女性更常见。由于健康女性在产后早期心脏功能也会发生生理变化，其诊断可能具有挑战性。本研究旨在：（i）确定产后即刻正常心脏生理与围产期心肌病病理变化之间的重叠；（ii）识别健康产后女性心脏功能和心脏生物标志物中任何种族特异性的变化。
我们对58名分娩后48小时内的健康产后女性和18名匹配的非孕对照进行了横断面研究。参与者接受了超声心动图和应变分析的心脏评估，其中40名产后女性进行了三维超声心动图检查。结果与12名回顾性研究的围产期心肌病患者进行了比较。健康产后女性的左心室容积和质量显著高于非孕对照，而射血分数和整体纵向应变较低。这些参数在围产期心肌病患者中受损更显著，但数值范围有重叠。与对照组相比，健康产后女性的肾上腺髓质素、胎盘生长因子（PlGF）和可溶性fms样酪氨酸激酶-1（sFlt1）水平更高。产后状态、肾上腺髓质素、sFlt1以及sFlt1:PlGF比值是健康产后女性左心室重构和功能的独立预测因素。
健康产后女性表现出左心室重构和功能降低的几个超声心动图指标，这与血管生成和心脏生物标志物水平的改变有关。
