Department of Anesthesia and Critical Care University of Chicago IL.
Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston MA.
J Am Heart Assoc. 2020 Jun 16;9(12):e015997. doi: 10.1161/JAHA.119.015997. Epub 2020 Jun 4.
Background Approximately 60% of women have Stage B heart failure 1 year after a preeclamptic delivery. Emerging evidence suggests that the profibrotic growth factor activin A, which has been shown to induce cardiac fibrosis and hypertrophy, is elevated in preeclampsia and may be inhibited by aspirin therapy. We hypothesized that preeclamptic women receiving aspirin would have lower activin A levels and reduced global longitudinal strain (GLS), a sensitive measure of cardiac dysfunction, than women who do not receive aspirin. To test our hypothesis, we performed a cohort study of women with preeclampsia or superimposed preeclampsia and compared activin A levels and GLS in parturients who did or did not receive aspirin. Methods and Results Ninety-two parturients were enrolled, of whom 25 (27%) received aspirin (81 mg/day) therapy. GLS, plasma activin A, and follistatin, which inactivates activin A, were measured. Women receiving aspirin therapy had lower median (interquartile range) levels of activin A (8.17 [3.70, 10.36] versus 12.77 [8.37, 31.25] ng/mL; =0.001) and lower activin/follistatin ratio (0.59 [0.31, 0.93] versus 1.01 [0.64, 2.60] =0.002) than women who did not receive aspirin, which also remained significant after multivariable analysis. Furthermore, GLS was worse in patients who did not receive aspirin (-19.84±2.50 versus -17.77±2.60%; =0.03) despite no differences in blood pressure between groups. Conclusions Our study suggests that antepartum aspirin therapy reduced serum activin A levels and improved GLS in preeclamptic patients, suggesting that aspirin may mitigate the postpartum cardiac dysfunction seen in women with preeclampsia.
大约 60%的女性在子痫前期分娩后 1 年会出现 B 期心力衰竭。新出现的证据表明，促纤维增生生长因子激活素 A 可诱导心肌纤维化和肥大，在子痫前期升高，并且可能被阿司匹林治疗抑制。我们假设接受阿司匹林治疗的子痫前期女性的激活素 A 水平较低，整体纵向应变（GLS）降低，这是一种心脏功能障碍的敏感指标，而未接受阿司匹林治疗的女性则不会。为了验证我们的假设，我们对患有子痫前期或叠加子痫前期的女性进行了队列研究，并比较了接受或不接受阿司匹林治疗的产妇的激活素 A 水平和 GLS。
共纳入 92 名产妇，其中 25 名（27%）接受阿司匹林（81mg/天）治疗。测量了 GLS、血浆激活素 A 和激活素 A 失活因子 follistatin。接受阿司匹林治疗的女性激活素 A 的中位数（四分位距）水平较低（8.17[3.70,10.36]与 12.77[8.37,31.25]ng/mL；=0.001），激活素/follistatin 比值较低（0.59[0.31,0.93]与 1.01[0.64,2.60]；=0.002），且在多变量分析后仍然具有统计学意义。此外，尽管两组之间的血压无差异，但未接受阿司匹林治疗的患者 GLS 更差（-19.84±2.50 与-17.77±2.60%；=0.03）。
我们的研究表明，产前阿司匹林治疗可降低子痫前期患者的血清激活素 A 水平并改善 GLS，这表明阿司匹林可能减轻子痫前期女性产后出现的心脏功能障碍。
