妊娠高血压疾病与晚年左心室重构的关系。
Association of Hypertensive Disorders of Pregnancy With Left Ventricular Remodeling Later in Life.
机构信息
University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA.
University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA.
出版信息
J Am Coll Cardiol. 2021 Mar 2;77(8):1057-1068. doi: 10.1016/j.jacc.2020.12.051.
BACKGROUND
Hypertensive disorders of pregnancy (HDP) are associated with short-term cardiac structure and function abnormalities, but later life changes are not well studied.
OBJECTIVES
This study aimed to determine if HDP history is associated with echocardiographic differences 8 to 10 years after delivery, and if subgroups with placental maternal vascular malperfusion (MVM) lesions or current hypertension may be particularly affected.
METHODS
Women with pregnancies delivered from 2008 to 2009 were selected from a clinical cohort with abstracted pregnancy and placental pathology data to undergo transthoracic echocardiography (2017 to 2020). Medical history, blood pressure, and weight were measured at the study visit.
RESULTS
The authors enrolled 132 women (10 ± 1 years post-delivery, age 38 ± 6 years): 102 with normotensive pregnancies and 30 with HDP: pre-eclampsia (n = 21) or gestational hypertension (n = 9). Compared with women with normotensive pregnancies, those with HDP history were more likely to have current hypertension (63% vs. 26%; p < 0.001). After adjusting for age, race, MVM lesions, body mass index, current hypertension, and hemoglobin A1c, women with HDP history had higher interventricular septal thickness (β = 0.08; p = 0.04) and relative wall thickness (β = 0.04; p = 0.04). In subgroup analyses, those with both HDP history and current hypertension had a higher proportion of left ventricular remodeling (79.0%) compared with all other groups (only HDP [36.4%; p = 0.01], only current hypertension [46.2%; p = 0.02], and neither HDP nor hypertension [38.2%; p < 0.001]), and lower mitral inflow E/A and annular e'. Accounting for placental MVM lesions did not impact results.
CONCLUSIONS
Women with both HDP history and current hypertension have pronounced differences in left ventricular structure and function a decade after pregnancy, warranting continued surveillance and targeted therapies for cardiovascular disease prevention.
背景
妊娠高血压疾病（HDP）与短期心脏结构和功能异常有关，但后期生活变化尚不清楚。
目的
本研究旨在确定 HDP 病史是否与分娩后 8 至 10 年的超声心动图差异有关，以及是否存在胎盘母体血管异常（MVM）病变或当前高血压的亚组可能受到特别影响。
方法
从具有妊娠和胎盘病理数据摘要的临床队列中选择 2008 年至 2009 年分娩的女性进行经胸超声心动图检查（2017 年至 2020 年）。在研究访问时测量病史、血压和体重。
结果
作者共纳入 132 名女性（分娩后 10 ± 1 年，年龄 38 ± 6 岁）：102 名血压正常的孕妇和 30 名 HDP 患者：子痫前期（n=21）或妊娠期高血压（n=9）。与血压正常的孕妇相比，有 HDP 病史的患者更有可能患有当前的高血压（63%比 26%；p<0.001）。在校正年龄、种族、MVM 病变、体重指数、当前高血压和糖化血红蛋白后，有 HDP 病史的患者室间隔厚度更高（β=0.08；p=0.04）和相对壁厚度（β=0.04；p=0.04）。在亚组分析中，同时患有 HDP 病史和当前高血压的患者左心室重构的比例更高（79.0%），而其他所有组的比例均较低（仅 HDP[36.4%；p=0.01]，仅当前高血压[46.2%；p=0.02]，两者均无 HDP 也无高血压[38.2%；p<0.001]），且二尖瓣流入 E/A 和环 e'较低。考虑到胎盘 MVM 病变并没有影响结果。
结论
患有 HDP 病史和当前高血压的女性在分娩后 10 年左右，左心室结构和功能存在明显差异，需要继续进行心血管疾病预防的监测和靶向治疗。
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