Breetveld N M, Ghossein-Doha C, van Kuijk S M J, van Dijk A P, van der Vlugt M J, Heidema W M, van Neer J, van Empel V, Brunner-La Rocca H-P, Scholten R R, Spaanderman M E A
Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Ultrasound Obstet Gynecol. 2017 Jan;49(1):134-142. doi: 10.1002/uog.16014.
After pre-eclampsia (PE), the prevalence of structural heart disease without symptoms, i.e. heart failure Stage B (HF-B), may be as high as one in four women in the first year postpartum. We hypothesize that a significant number of formerly pre-eclamptic women with HF-B postpartum are still in their resolving period and will not have HF-B during follow-up.
In this prospective longitudinal cohort study, we included 69 formerly pre-eclamptic women who underwent serial echocardiographic measurements at 1 and 4 years postpartum. HF-B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) > 95 g/m ), concentric remodeling (relative wall thickness > 0.42 and LVMi ≤ 95 g/m ), mild systolic dysfunction (left ventricular ejection fraction > 40% and < 55%) or asymptomatic valvular disease. Women were subdivided and analyzed according to HF-B outcome: no HF-B at either visit; HF-B at first visit only; HF-B at second visit only; HF-B at both visits.
The prevalence of HF-B in formerly pre-eclamptic women was 23% in the first year postpartum and 23% after 4 years. At the second visit, HF-B had resolved in 62.5% of affected women but was newly developed in 19% of initially unaffected women. At the first visit, 56% of women diagnosed with HF-B had reduced systolic function whereas at the second visit 69% of women with HF-B had concentric remodeling with mostly normal ejection fraction, consistent with diastolic dysfunction.
The prevalence of HF-B can be considered consistently high (1 in 4) amongst formerly pre-eclamptic women at follow-up. Nonetheless, at an individual level, more than 60% of women found initially to be affected by HF-B will recover, whilst about 20% of formerly pre-eclamptic women with normal echocardiography in the first year postpartum will develop HF-B over the following years. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
子痫前期（PE）后，无症状结构性心脏病即心力衰竭B期（HF - B）的患病率在产后第一年可能高达四分之一的女性。我们推测，相当数量产后患有HF - B的子痫前期既往患者仍处于病情缓解期，随访期间不会患有HF - B。
在这项前瞻性纵向队列研究中，我们纳入了69名子痫前期既往患者，她们在产后1年和4年接受了系列超声心动图测量。HF - B被诊断为左心室肥厚（左心室质量指数（LVMi）> 95 g/m²）、向心性重塑（相对室壁厚度> 0.42且LVMi≤95 g/m²）、轻度收缩功能障碍（左心室射血分数> 40%且< 55%）或无症状瓣膜病。根据HF - B结局对女性进行细分和分析：两次检查均无HF - B；仅首次检查时有HF - B；仅第二次检查时有HF - B；两次检查均有HF - B。
子痫前期既往患者中HF - B的患病率在产后第一年为23%，4年后为23%。在第二次检查时，62.5%的受影响女性HF - B已缓解，但19%最初未受影响的女性新出现了HF - B。在首次检查时，56%被诊断为HF - B的女性收缩功能降低，而在第二次检查时，69%患有HF - B的女性有向心性重塑且射血分数大多正常，表示存在舒张功能障碍。
随访中，子痫前期既往患者中HF - B的患病率可被认为持续较高（四分之一）。尽管如此，在个体层面，最初被发现受HF - B影响的女性中超过60%将康复，而约20%产后第一年超声心动图正常的子痫前期既往女性在随后几年中将发展为HF - B。版权所有© 2016 ISUOG。由John Wiley & Sons Ltd出版。
