Department of Cardiology.
Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana.
J Hypertens. 2020 Jul;38(7):1367-1374. doi: 10.1097/HJH.0000000000002406.
In women with severe preeclampsia the period immediately before and early postdelivery carries the greatest risk for cardiac decompensation due to acute changes in loading conditions. The authors aimed to evaluate dynamic changes in hemodynamic and echocardiographic-derived systolic and diastolic function parameters in preeclamptic women compared with healthy controls.
Thirty women with severe preeclampsia and 30 healthy controls underwent transthoracic echocardiography 1 day before, 1 and 4 days postdelivery. Fluid responsiveness was assessed by passive leg raising.
Peak systolic myocardial velocities (s') and global longitudinal strain (GLS) were significantly lower in preeclamptic group compared with controls only postdelivery (s': 7.3 ± 0.8 vs. 8.3 ± 0.9 cm/s, P < 0.001; GLS: -21.4 ± 2.0 vs. -23.0 ± 1.4%, P = 0.027). In addition, significant decrease in s' after delivery was observed only in preeclamptic group (P = 0.004). For diastolic parameters there were differences both before and postdelivery in E/e' ratio (before: 8.4 ± 2.16 vs. 6.7 ± 1.89, P = 0.002; postdelivery: 8.3 ± 1.64 vs. 6.8 ± 1.27, P = 0.003) and mitral e' velocity (before: 11.0 ± 2.39 vs. 12.6 ± 1.86, P = 0.004; postdelivery: 11.1 ± 2.28 vs. 14.0 ± 2.40 cm/s, P < 0.001). Significant increase in left ventricular stroke volume (P = 0.005) and transmitral E velocity (P = 0.003) was observed only in control group, reflecting response to volume load after delivery. Accordingly, only the minority of preeclamptic women were fluid responsive (11 vs. 43%, P = 0.014 between groups).
Variations in cardiac parameters in healthy women seem to follow changes in loading conditions before and early after delivery. Different pattern in preeclamptic women, however, may be related to subtle myocardial dysfunction, that becomes uncovered with augmented volume load in early postpartum period.
在患有严重先兆子痫的女性中，由于负荷条件的急性变化，分娩前和产后早期是心脏失代偿的风险最大时期。作者旨在评估与健康对照组相比，先兆子痫女性的血流动力学和超声心动图衍生的收缩和舒张功能参数的动态变化。
30 名患有严重先兆子痫的女性和 30 名健康对照者在分娩前 1 天、分娩后 1 天和 4 天接受经胸超声心动图检查。通过被动抬腿评估液体反应性。
仅在分娩后，收缩期心肌速度峰值（s'）和整体纵向应变（GLS）在先兆子痫组中显著低于对照组（s'：7.3±0.8 与 8.3±0.9 cm/s，P<0.001；GLS：-21.4±2.0 与-23.0±1.4%，P=0.027）。此外，仅在先兆子痫组中观察到分娩后 s'的显著下降（P=0.004）。对于舒张参数，E/e' 比值在前和分娩后均有差异（前：8.4±2.16 与 6.7±1.89，P=0.002；分娩后：8.3±1.64 与 6.8±1.27，P=0.003）和二尖瓣 e'速度（前：11.0±2.39 与 12.6±1.86，P=0.004；分娩后：11.1±2.28 与 14.0±2.40 cm/s，P<0.001）。仅在对照组中观察到左心室每搏量（P=0.005）和经二尖瓣 E 速度（P=0.003）的显著增加，这反映了分娩后对容量负荷的反应。相应地，只有少数先兆子痫女性对液体有反应（11%与 43%，P=0.014）。
健康女性的心脏参数变化似乎遵循分娩前和产后早期的负荷条件变化。然而，先兆子痫女性的不同模式可能与微妙的心肌功能障碍有关，这种功能障碍在产后早期增加容量负荷时会显现出来。
