Ambia Anne M, Morgan Jamie L, Wilson Karen L, Roberts Scott W, Wells C Edward, McIntire Donald D, Sanghavi Monika, Nelson David B, Cunningham F Gary
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Am J Obstet Gynecol. 2017 Oct;217(4):467.e1-467.e6. doi: 10.1016/j.ajog.2017.05.061. Epub 2017 Jun 8.
Ventricular hypertrophy is a known sequela of long-standing chronic hypertension with associated morbidity and mortality.
We sought to assess the frequency and importance of left ventricular hypertrophy in gravidas treated for chronic hypertension during pregnancy.
This was a retrospective study of pregnant women with chronic hypertension who were delivered at our hospital from January 2009 through February 2015. All women who were given antihypertensive therapy underwent maternal echocardiography and were managed in a dedicated, high-risk prenatal clinic. Left ventricular hypertrophy was defined using the criteria of the American Society of Echocardiography as left ventricular mass indexed to maternal body surface area with a value of >95 g/m. Maternal and infant outcomes were then analyzed according to the presence or absence of left ventricular hypertrophy.
Of 253 women who underwent echocardiography, 48 (19%) met criteria for left ventricular hypertrophy. Women in this latter cohort were significantly more likely to be African American (P = .031), but there were no other demographic differences. More than 85% of the entire cohort had a body mass index >30 kg/m and a third of all women had class III obesity with a body mass index of >40 kg/m. Importantly, duration of chronic hypertension (P = .248) and gestational age at time of echocardiography (P = .316) did not differ significantly between the groups. Left ventricular function was preserved in both groups as measured by left ventricular ejection fraction (P = .303). Those with ventricular hypertrophy were at greater risk to be delivered preterm (P = .001), to develop superimposed preeclampsia (P = .028), and to have an infant requiring intensive care (P = .023) when compared with women without ventricular hypertrophy. These findings persisted after adjustment for age, race, and parity. The gestational age at delivery according to measured left ventricular size was also examined and with increasing ventricular mass there was a significant association with the severity of preterm birth (P < .001).
Left ventricular hypertrophy was identified in 1 in 5 women given antepartum treatment for chronic hypertension. Further analysis showed that these women were at significantly greater risk for superimposed preeclampsia and its attendant perinatal sequelae of preterm birth.
心室肥厚是长期慢性高血压已知的后遗症，伴有发病和死亡风险。
我们试图评估孕期接受慢性高血压治疗的孕妇中左心室肥厚的发生率及其重要性。
这是一项对2009年1月至2015年2月在我院分娩的慢性高血压孕妇进行的回顾性研究。所有接受降压治疗的女性均接受了母体超声心动图检查，并在专门的高危产前诊所接受管理。左心室肥厚采用美国超声心动图学会的标准定义为左心室质量与母体体表面积的比值>95 g/m²。然后根据有无左心室肥厚分析母婴结局。
在接受超声心动图检查的253名女性中，48名（19%）符合左心室肥厚标准。后一组女性中非裔美国人的比例显著更高（P = 0.031），但在其他人口统计学特征上没有差异。整个队列中超过85%的女性体重指数>30 kg/m²，三分之一的女性患有III级肥胖，体重指数>40 kg/m²。重要的是，两组之间慢性高血压的病程（P = 0.248）和超声心动图检查时的孕周（P = 0.316）没有显著差异。通过左心室射血分数测量，两组的左心室功能均得以保留（P = 0.303）。与无心室肥厚的女性相比，有心室肥厚的女性早产风险更高（P = 0.001）、发生子痫前期的风险更高（P = 0.028），且婴儿需要重症监护的风险更高（P = 0.023）。在对年龄、种族和产次进行调整后，这些结果仍然存在。还根据测量的左心室大小检查了分娩时的孕周，随着心室质量增加，与早产严重程度存在显著关联（P < 0.001）。
在接受产前慢性高血压治疗的女性中，五分之一的女性被发现有左心室肥厚。进一步分析表明，这些女性发生子痫前期及其伴随的早产围产期后遗症的风险显著更高。
