Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Matern Fetal Neonatal Med. 2022 Nov;35(21):4104-4109. doi: 10.1080/14767058.2020.1847070. Epub 2020 Nov 23.
To assess pulmonary artery pressure and cardiac remodeling in pregnancy in women with pulmonary hypertension and compare these findings with studies done beyond three months postpartum.
Pregnant women with pulmonary hypertension from 2006 to 2017 were studied. Pulmonary hypertension was diagnosed when the pulmonary artery pressure exceeded 30 mmHg as estimated by right ventricular systolic pressure (RVSP) on echocardiography or 20 mmHg measured directly by mean pulmonary artery pressure (PAPm) with right-heart catheterization (RHC). Disease severity was assigned using threshold cutoffs. Indices of cardiac remodeling were compared during pregnancy after 20 weeks' gestation and again beyond three months postpartum when available. Pulmonary artery pressures obtained by echocardiography versus right-heart catheterization were also compared.
Forty-six pregnancies complicated by pulmonary hypertension in 41 women were identified. The study included 43 pregnancies that resulted in a livebirth. There were 20 women in whom studies were performed after 20 weeks' gestation and again at least 3 months postpartum or later. Pulmonary artery pressures determined during pregnancy versus beyond three months postpartum were not significantly different when measured by echocardiography (RVSP 53.5 ± 20.5 mmHg and 46.7 ± 20.4 mmHg, = .26) in this limited cohort. In the 10 women in whom pulmonary artery pressures were measured with both echocardiography and right-heart catheterization, the former was found to significantly overestimate directly measured pulmonary artery pressure (63.3 ± 20.7 versus 37.7 ± 12.3 mmHg, < .001).
Pulmonary artery pressures did not appreciably change during pregnancy after 20 weeks' gestation compared with pressures measured again beyond three months postpartum. Women with pulmonary hypertension did not show evidence of remodeling of left ventricular mass or relative wall thickness when measured in pregnancy after 20 weeks' gestation compared with beyond three months postpartum in this limited cohort. These findings suggest that cardiac remodeling in women with pulmonary hypertension is different from that of normally pregnant women and confirms the need for careful long-term follow-up.
评估妊娠合并肺动脉高压患者的肺动脉压和心脏重构，并将这些发现与产后三个月以上的研究进行比较。
研究了 2006 年至 2017 年患有肺动脉高压的妊娠妇女。通过超声心动图估计右心室收缩压（RVSP）超过 30mmHg 或通过右心导管测量平均肺动脉压（PAPm）直接测量 20mmHg 诊断肺动脉高压。使用阈值截止值来分配疾病严重程度。在妊娠 20 周后进行比较，并在有条件时再次在产后三个月以上进行比较心脏重构指数。还比较了超声心动图与右心导管测量的肺动脉压。
确定了 41 名女性的 46 例妊娠合并肺动脉高压。该研究包括 43 例活产妊娠。有 20 名女性在妊娠 20 周后进行了研究，并且至少在产后 3 个月或更长时间后再次进行了研究。在这个有限的队列中，通过超声心动图测量的怀孕期间与产后三个月以上的肺动脉压没有显著差异（RVSP 53.5 ± 20.5mmHg 和 46.7 ± 20.4mmHg，=.26）。在 10 名女性中，同时用超声心动图和右心导管测量了肺动脉压，前者明显高估了直接测量的肺动脉压（63.3 ± 20.7 与 37.7 ± 12.3mmHg，<.001）。
与产后三个月以上的压力相比，妊娠 20 周后肺动脉压没有明显变化。在这个有限的队列中，与产后三个月以上的压力相比，在妊娠 20 周后测量时，患有肺动脉高压的女性没有表现出左心室质量或相对壁厚度重构的证据。这些发现表明，肺动脉高压女性的心脏重构与正常妊娠女性不同，并证实了需要进行仔细的长期随访。
