Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India.
Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):8394-8399. doi: 10.1080/14767058.2021.1974834. Epub 2021 Sep 5.
Cardiac remodeling and diastolic dysfunction may occur, in women with early-onset preeclampsia, following raised total vascular resistance in response to the impaired placentation. These changes can increase the risk of premature cardiac morbidity and mortality later in life. According to updated guidelines by the American and European Societies of Echocardiography (ASE/ESE) to diagnose diastolic dysfunction, using a simpler criterion is not yet used in pregnant women.
To compare the maternal cardiovascular changes and the variation in the diastolic dysfunction using the 2009 and 2016 criteria by ASE/ESE among women with early onset preeclampsia and gestational age-matched normotensive controls.
A prospective matched cross-sectional study conducted in a tertiary hospital in South India, involving 40 women with early and 40 women with gestational age-matched normotensive controls. Cardiac function and remodeling were assessed by conventional 2D, M-mode, and Doppler echocardiography.
Compared to the controls, women with early-onset preeclampsia had significantly higher. Total vascular resistance index (2867.6 vs. 2277.2 dynes/s/cm/m, = .035) and median end-systolic stress index (5.2 vs. 9.2 dyne/cm/m), suggesting a higher afterload. Cases had a significant rate of left ventricular diastolic dysfunction using the 2009 criteria (grade II/III: 21 (52%) vs. 0 (0%), <.001) whereas the rates were much lower when the updated 2016 guidelines were used (grade II/III: 9 (22.5%) vs. 1 (2.5%), <.001).
In women with early-onset preeclampsia, cardiovascular adaption occurs to minimize wall stress and myocardial oxygenation. The prevalence of diastolic dysfunction was observed to be lower with the 2016 criteria. Further studies involving pregnant women are required to assess the impact of newer guidelines on association with short- and long-term cardiovascular outcomes in high-risk women.
由于胎盘功能障碍导致总血管阻力增加，早期子痫前期患者可能会出现心肌重构和舒张功能障碍。这些变化会增加女性日后罹患心脏疾病和过早死亡的风险。根据美国和欧洲超声心动图学会（ASE/ESE）最新的舒张功能障碍诊断指南，在孕妇中尚未使用更简单的标准。
比较使用 ASE/ESE 2009 年和 2016 年标准的早期子痫前期患者与孕龄匹配的正常血压对照组之间的产妇心血管变化和舒张功能障碍的变化。
这是在印度南部的一家三级医院进行的前瞻性匹配的病例对照研究，共纳入 40 例早期子痫前期患者和 40 例孕龄匹配的正常血压对照组。采用常规二维、M 型和多普勒超声心动图评估心功能和重构。
与对照组相比，早期子痫前期患者的总血管阻力指数（2867.6 对 2277.2 dynes/s/cm/m， = .035）和中位收缩末期压力指数（5.2 对 9.2 dyne/cm/m）显著更高，提示后负荷更高。使用 2009 年标准，病例组有较高的左心室舒张功能障碍发生率（二级/三级：21（52%）对 0（0%），<.001），而使用更新的 2016 年指南时，发生率要低得多（二级/三级：9（22.5%）对 1（2.5%），<.001）。
在早期子痫前期患者中，心血管适应会最小化壁应力和心肌氧合。使用 2016 年标准观察到舒张功能障碍的发生率较低。需要进一步研究孕妇，以评估新指南对高危女性短期和长期心血管结局的影响。
