Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan.
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
BMC Pregnancy Childbirth. 2020 Dec 2;20(1):750. doi: 10.1186/s12884-020-03452-3.
This study aimed to compare the echocardiographic changes and cardiac biomarkers between women with singleton and twin pregnancies.
From April 2014 to March 2016, this longitudinal cohort study invited pregnant women who were scheduled to give birth at Hokkaido University Hospital. We analyzed prospectively collected data on simultaneously determined echocardiographic parameters and blood cardiac markers of 44 women with singleton and 22 women with twin pregnancies. Furthermore, we tested the mixed-effect models for echocardiographic parameters and cardiac biomarkers.
During the third trimester and immediately postpartum (within 1 week after childbirth), the mean left atrial volume index and brain natriuretic peptide (BNP) level were significantly higher in women with twin pregnancies than in those with singleton pregnancies. Women with twin pregnancies also had significantly smaller second-trimester inferior vena cava diameters and significantly higher thirdtrimester creatinine levels than those with singleton pregnancies. BNP positively correlated with the left atrial volume index (β = 0.49, p < 0.01) and the ratio of early diastolic transmitral to mitral annular velocity (E/e') (β = 0.41, p < 0.01). At 1 month after childbirth in women with singleton pregnancies, BNP and N-terminal precursor protein BNP (NT-proBNP) fragments immediately postpartum negatively correlated with the later E/e' (r = - 0.33, p = 0.02 and r = - 0.36, p < 0.01, respectively).
The intravascular cardiac load reached maximum within 1 week after childbirth and was greater in women with twin pregnancies than in those with singleton pregnancies. BNP/NT-proBNP significantly positively correlated with LA volume index and E/e'. In women with singleton pregnancies, BNP secreted immediately after childbirth might improve the diastolic functions 1 month after childbirth.
本研究旨在比较单胎和双胎妊娠女性的超声心动图变化和心脏生物标志物。
本纵向队列研究于 2014 年 4 月至 2016 年 3 月期间邀请了计划在北海道大学医院分娩的孕妇。我们分析了 44 例单胎妊娠和 22 例双胎妊娠孕妇同时确定的超声心动图参数和血液心脏标志物的前瞻性收集数据。此外，我们还测试了超声心动图参数和心脏生物标志物的混合效应模型。
在孕晚期和产后即刻（产后 1 周内），双胎妊娠女性的左心房容积指数和脑钠肽（BNP）水平明显高于单胎妊娠女性。与单胎妊娠女性相比，双胎妊娠女性的中孕期下腔静脉直径较小，孕晚期肌酐水平较高。BNP 与左心房容积指数呈正相关（β=0.49，p<0.01）和早期舒张期经二尖瓣环速度与二尖瓣瓣环速度比（E/e'）呈正相关（β=0.41，p<0.01）。在单胎妊娠女性产后 1 个月时，BNP 和 N 末端前体脑钠肽（NT-proBNP）片段产后即刻与晚期 E/e'呈负相关（r=-0.33，p=0.02 和 r=-0.36，p<0.01）。
分娩后 1 周内心血管负荷达到最大值，双胎妊娠女性大于单胎妊娠女性。BNP/NT-proBNP 与 LA 容积指数和 E/e'显著正相关。在单胎妊娠女性中，产后即刻分泌的 BNP 可能会改善产后 1 个月的舒张功能。
