Department of Anesthesiology, University Hospital Basel, Basel, Switzerland.
Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK.
Ultrasound Obstet Gynecol. 2019 Sep;54(3):344-349. doi: 10.1002/uog.20170.
Obesity is an increasing problem worldwide, with well recognized detrimental effects on cardiovascular health; however, very little is known about the effect of obesity on cardiovascular adaptation to pregnancy. The aim of the present study was to compare biventricular cardiac function at term between obese pregnant women and pregnant women with normal body weight, utilizing conventional echocardiography and speckle-tracking assessment.
This was a prospective case-control study of 40 obese, but otherwise healthy, pregnant women with a body mass index (BMI) of ≥ 35 kg/m and 40 healthy pregnant women with a BMI of ≤ 30 kg/m . All women underwent a comprehensive echocardiographic examination and speckle-tracking assessment at term.
Obese pregnant women, compared with controls, had significantly higher systolic blood pressure (117 vs 109 mmHg; P = 0.002), cardiac output (6.73 vs 4.90 L/min; P < 0.001), left ventricular (LV) mass index (74 vs 64 g/m ; P < 0.001) and relative wall thickness (0.43 vs 0.37; P < 0.001). Diastolic dysfunction was present in five (12.5%) controls and 16 (40%) obese women (P = 0.004). In obese women, compared with controls, LV global longitudinal strain (-15.59 vs -17.61%; P < 0.001), LV endocardial (-17.30 vs -19.84%; P < 0.001) and epicardial (-13.10 vs -15.73%; P < 0.001) global longitudinal strain as well as LV early diastolic strain rate (1.05 vs 1.24 /s; P = 0.006) were all significantly reduced. No differences were observed in the degree of LV twist and torsion between the two groups.
Morbidly obese, but otherwise healthy, pregnant women at term had significant LV hypertrophy with evidence of diastolic dysfunction and impaired deformation indices compared with pregnant women of normal weight. These findings are likely to represent a maladaptive response of the heart to volume overload in obese pregnancy. The impact of theses changes on pregnancy outcome and long-term maternal outcome is unclear. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
肥胖是一个日益严重的全球性问题，其对心血管健康的危害已得到广泛认识；然而，人们对肥胖对心血管系统适应妊娠的影响知之甚少。本研究旨在利用常规超声心动图和斑点追踪评估比较肥胖孕妇与体重正常孕妇在妊娠末期的左右心室心脏功能。
这是一项前瞻性病例对照研究，纳入 40 名肥胖但健康的孕妇，这些孕妇的体质指数（BMI）≥35kg/m2，另外纳入 40 名 BMI≤30kg/m2 的健康孕妇。所有孕妇在妊娠末期均接受全面的超声心动图检查和斑点追踪评估。
与对照组相比，肥胖孕妇的收缩压（117 比 109mmHg；P=0.002）、心输出量（6.73 比 4.90L/min；P<0.001）、左心室（LV）质量指数（74 比 64g/m2；P<0.001）和相对壁厚度（0.43 比 0.37；P<0.001）更高。对照组中有 5 名（12.5%）孕妇和 16 名（40%）肥胖孕妇存在舒张功能障碍（P=0.004）。与对照组相比，肥胖孕妇的 LV 整体纵向应变（-15.59 比-17.61%；P<0.001）、LV 心内膜（-17.30 比-19.84%；P<0.001）和心外膜（-13.10 比-15.73%；P<0.001）整体纵向应变以及 LV 早期舒张应变率（1.05 比 1.24/s；P=0.006）均显著降低。两组间 LV 扭转和扭转程度无差异。
肥胖但健康的足月孕妇存在明显的 LV 肥厚，伴有舒张功能障碍和变形指数受损，与体重正常的孕妇相比，这可能代表了心脏对肥胖妊娠时容量过载的适应性反应。这些变化对妊娠结局和长期母婴结局的影响尚不清楚。版权所有 © 2018 ISUOG。由 John Wiley & Sons Ltd 出版。
