Department of Obstetrics and Gynaecology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands.
Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands.
PLoS One. 2018 Jun 12;13(6):e0198908. doi: 10.1371/journal.pone.0198908. eCollection 2018.
Systemic inflammation, endothelial dysfunction and deficient vascularization of either uterus or myocardium are mechanistic hallmarks of early-onset preeclampsia and heart failure with preserved ejection fraction (HFpEF). HFpEF is especially prevalent in elderly women and preceded in middle age by preclinical left ventricular (LV) diastolic dysfunction. To detect if preeclampsia predisposes to HFpEF at later age, echocardiographic indices of LV function and of LV structure and biomarkers of systemic inflammation and of endothelial dysfunction were compared in middle-aged women with a history of early-onset preeclampsia or uncomplicated pregnancy.
Middle-aged women with a history of early-onset preeclampsia (n = 131) or uncomplicated pregnancy (n = 56) were prospectively recruited 9 to 16 years after pregnancy. Women with a history of preeclampsia had higher body mass index (p = 0.006), blood pressure (p<0.001) and plasma levels of interleukin-6 (p = 0.005) and soluble intercellular adhesion molecule-1 (sICAM-1) (p = 0.014). They had thicker septal (p = 0.001) and posterior (p = 0.003) LV walls and worse diastolic LV function evident from reduced mean mitral annular lengthening velocity (E'mean; p = 0.007) and higher ratio of early diastolic mitral flow velocity (E) over E'mean (E/E'mean; p<0.001). Differences of sICAM-1, E'mean and E/E'mean remained significant after accounting for BMI and blood pressure.
History of preeclampsia predisposes in middle age to worse LV diastolic function, which could increase the likelihood of later HFpEF development. This predisposition derives not only from persistent cardiovascular risk but may also be caused by persistent endothelial dysfunction hindering adequate vascularization in the uterus during pregnancy and in the myocardium in middle age.
全身性炎症、内皮功能障碍以及子宫或心肌血管生成不足是早发型子痫前期和射血分数保留型心力衰竭（HFpEF）的发病机制特征。HFpEF 在老年女性中尤为常见，在中年时，会出现亚临床左心室（LV）舒张功能障碍。为了检测子痫前期是否会导致以后年龄发生 HFpEF，本研究比较了有早发型子痫前期或单纯妊娠史的中年女性的 LV 功能和 LV 结构的超声心动图指标，以及全身炎症和内皮功能障碍的生物标志物。
前瞻性招募了 9 至 16 年后有早发型子痫前期（n = 131）或单纯妊娠史（n = 56）的中年女性。有子痫前期病史的女性体重指数更高（p = 0.006）、血压更高（p<0.001）、白细胞介素-6（p = 0.005）和可溶性细胞间黏附分子-1（sICAM-1）（p = 0.014）的血浆水平更高。她们的室间隔（p = 0.001）和左心室后壁（p = 0.003）更厚，左心室舒张功能更差，表现在平均二尖瓣环缩短速度（E'mean；p = 0.007）降低和舒张早期二尖瓣血流速度（E）与 E'mean 的比值（E/E'mean；p<0.001）更高。在考虑 BMI 和血压后，sICAM-1、E'mean 和 E/E'mean 的差异仍然显著。
子痫前期病史会导致中年时左心室舒张功能恶化，这可能会增加以后发生 HFpEF 的可能性。这种易感性不仅源于持续的心血管风险，还可能源于持续的内皮功能障碍，这会妨碍妊娠期间子宫和中年时期心肌的充分血管生成。
