Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.
Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
Hypertens Res. 2019 Apr;42(4):522-529. doi: 10.1038/s41440-018-0163-9. Epub 2018 Dec 14.
Excessive left ventricular (LV) mass (LVM) increase results in inefficient LV work with high energy waste and a negative prognostic effect. We aimed to investigate the presence of inappropriate LVM and to calculate the myocardial mechanoenergetic efficiency index (MEEi) in asymptomatic women with a history of early-onset (EO) or late-onset (LO) pre-eclampsia (PE). Among all women diagnosed with PE in the years 2009-2013, after applying inclusion/exclusion criteria and cost-effectiveness analysis, we randomly selected thirty women who experienced EO-PE, thirty with a previous LO-PE and thirty healthy controls to undergo echocardiography from 6 months to 4 years after delivery. Data regarding gestational age (GA) and mean uterine artery (UtA) pulsatility index (PI) at PE onset were collected from medical records. All women were free from cardiovascular risk factors. LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was calculated as the ratio between stroke work and "double product" (to approximate energy consumption), indexed to LVM. Concentric remodeling was present in 60% of EO-PE and 53% of LO-PE. LVM excess was significantly more often present in the EO-PE group than in the control group. LVM was inappropriate in 52% of EO-PE and 17% of LO-PE. MEEi showed a tendency towards lower values in the EO-PE group. Multivariate regression analysis showed that both LVM excess and MEEi were independently associated with lower GA and higher mean UtA PI at PE onset. Inappropriate LVM with a tendency towards reduced MEEi in the first 4 years after delivery may partially explain the elevated cardiovascular risk in former pre-eclamptic women compared to the general population.
左心室（LV）质量（LVM）过度增加导致 LV 工作效率低下，能量浪费高，预后不良。我们旨在研究无症状的有早发（EO）或晚发（LO）子痫前期（PE）病史的女性中是否存在不适当的 LVM，并计算心肌机械能量效率指数（MEEi）。在 2009 年至 2013 年间诊断出的所有 PE 女性中，经过纳入/排除标准和成本效益分析后，我们随机选择了 30 名经历过 EO-PE 的女性、30 名 LO-PE 前期的女性和 30 名健康对照组，在分娩后 6 个月至 4 年内接受超声心动图检查。从病历中收集了与妊娠年龄（GA）和 PE 发病时平均子宫动脉（UtA）搏动指数（PI）相关的数据。所有女性均无心血管危险因素。LVM 过量是通过观察到的 LVM 与通过性别、stroke work 和身高预测的 LVM 的比值计算得出的，而 MEEi 是通过 stroke work 与“双乘积”（近似能量消耗）的比值计算得出的，以 LVM 为指数。60%的 EO-PE 和 53%的 LO-PE 存在向心性重构。EO-PE 组的 LVM 过量显著高于对照组。EO-PE 组中有 52%的 LVM 过量，而 LO-PE 组中有 17%的 LVM 过量。EO-PE 组的 MEEi 有降低的趋势。多变量回归分析显示，LVM 过量和 MEEi 均与较低的 GA 和较高的 PE 发病时平均 UtA PI 独立相关。在分娩后 4 年内，LVM 不适当且 MEEi 呈降低趋势，这可能部分解释了与一般人群相比，前子痫前期女性的心血管风险升高。
