Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health.
Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia.
J Hypertens. 2019 Feb;37(2):356-364. doi: 10.1097/HJH.0000000000001888.
To compare the elastic properties of the ascending aorta and ventricular-arterial coupling (VAC) in women with a previous pregnancy complicated by hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, women who experienced preeclampsia, and healthy controls.
Women with a history of preeclampsia (n = 60) or HELLP syndrome (n = 49) and matched healthy controls (n = 60) underwent transthoracic echocardiography at 6 months to 4 years after delivery. Aortic M-mode and tissue Doppler imaging (TDI) parameters were measured. Aortic diameters were assessed at end-diastole at four levels: Valsalva sinuses, sinotubular junction, tubular tract, and aortic arch. Aortic compliance, distensibility, stiffness index, Peterson's elastic modulus, pulse-wave velocity, and M-mode strain were calculated using standard formulae. Aortic expansion velocity, early and late diastolic retraction velocities, and peak systolic tissue strain (TDI-ε) were determined. VAC was defined as the ratio between aortic elastance (Ea) and left ventricular end-systolic elastance (Ees). All women were free from cardiovascular risk factors.
Women with a history of HELLP syndrome showed larger aortas than those with previous preeclampsia or controls, probably related to a higher blood pressure. Aortic elastic properties, including Ea, were similar between HELLP and preeclampsia groups, even comparing cases with early-onset preeclampsia and HELLP. In contrast, Ees was more impaired in the HELLP group than in the other two. Consequently, about one-quarter of women who experienced HELLP syndrome had a pathological VAC, whereas only 5% of previously preeclamptic patients did. Multivariate analysis confirmed the association between HELLP syndrome and VAC, whereas other parameters including aortic compliance, distensibility, stiffness index, and elastic modulus are linked only to gestational age at preeclampsia onset, ad also Ea and Ees did.
We found a significant overlap between the aortic elastic properties in women with a history of preeclampsia and those with a previous HELLP syndrome, suggesting a common pathophysiologic pathway. However, women who experienced HELLP syndrome showed a higher blood pressure than other cases and controls, probably determining larger aortas. In addition, VAC was more altered in the HELLP group than in the others because of a higher Ea and a lower Ees.
比较既往妊娠合并溶血性肝酶升高和血小板减少（HELLP）综合征、子痫前期及健康对照妇女升主动脉弹性及心室-动脉偶联（VAC）的差异。
本研究纳入产后 6 个月至 4 年的既往子痫前期（n=60）或 HELLP 综合征（n=49）妇女及匹配健康对照（n=60），行经胸超声心动图检查。测量升主动脉 M 型及组织多普勒超声心动图参数。在舒张末期于四个部位（Valsalva 窦、窦管交界、管状部及主动脉弓）测量升主动脉直径。采用标准公式计算升主动脉顺应性、扩张性、僵硬度指数、Peterson 弹性模量、脉搏波速度及 M 型应变。测量升主动脉膨胀速度、舒张早期及晚期回缩速度及收缩期组织峰值应变（TDI-ε）。VAC 定义为主动脉弹性（Ea）与左心室收缩末期弹性（Ees）的比值。所有患者均无心血管危险因素。
既往 HELLP 综合征患者升主动脉较既往子痫前期及对照组大，可能与血压较高相关。既往 HELLP 综合征及子痫前期患者主动脉弹性参数（Ea）相似，即使是早发型子痫前期及 HELLP 综合征患者。相反，HELLP 综合征患者 Ees 较其他两组受损更明显。因此，约 1/4 的 HELLP 综合征患者存在病理性 VAC，而仅有 5%的既往子痫前期患者存在病理性 VAC。多变量分析证实了 HELLP 综合征与 VAC 相关，而其他参数如主动脉顺应性、扩张性、僵硬度指数及弹性模量仅与子痫前期发病时的孕龄相关，Ea 和 Ees 也与孕龄相关。
我们发现既往子痫前期及既往 HELLP 综合征患者升主动脉弹性具有显著重叠性，提示存在共同的病理生理途径。然而，既往 HELLP 综合征患者血压高于其他患者及对照组，可能导致升主动脉较大。此外，由于 Ea 较高及 Ees 较低，HELLP 组的 VAC 改变更明显。
