Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy; Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), the Netherlands.
Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), the Netherlands.
Pregnancy Hypertens. 2022 Mar;27:16-22. doi: 10.1016/j.preghy.2021.11.003. Epub 2021 Nov 12.
Excessive left ventricular mass (LVM) results in inefficient LV work with energy waste leading to a negative prognostic effect. We aimed at investigating the presence of inappropriate LVM and calculating the myocardial mechano-energetic efficiency index (MEEi) in former pre-eclamptic (PE) women (with or without HELLP syndrome) compared to women who experienced HELLP syndrome without PE.
In this cross-sectional study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent echocardiography as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity.
LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was considered as the ratio between stroke work and "double product" (to approximate energy consumption), indexed to LVM.
LV hypertrophy was present in 8-14% and concentric remodeling in 31-42% of women, without intergroup difference. LVM was inappropriate in one-third of normotensive former HELLP and in about one-half of PE with or without HELLP, with no difference among groups. Accordingly, without nominal difference, MEEi showed a tendency towards lower values in former pre-eclamptic individuals.
Women with a history of HELLP syndrome, independently from the presence/absence of PE, showed inappropriate LVM in the first 4 years after delivery, which may partially explain the elevated CV risk in these women compared to the general female population.
左心室质量（LVM）过度会导致 LV 工作效率低下，能量浪费，从而产生负面预后效应。本研究旨在调查既往子痫前期（PE）妇女（有无 HELLP 综合征）中是否存在不适当的 LVM，并计算心肌力学-能量效率指数（MEEi），与经历无 PE 的 HELLP 综合征的妇女进行比较。
在这项横断面研究中，32 名既往血压正常的 HELLP 患者、59 名无 HELLP 的 PE 患者和 101 名有 HELLP 的 PE 患者在产后 6 个月至 4 年内进行了超声心动图检查，作为其复杂妊娠后临床心血管检查的一部分。我们排除了患有合并症的妇女，包括慢性高血压、高胆固醇血症和肥胖症。
左心室质量过多是通过观察 LVM 与预测 LVM（通过性别、stroke work 和身高）的比值来计算的，而 MEEi 则被认为是 stroke work 与“双乘积”（近似能量消耗）的比值，以 LVM 为指标。
8-14%的女性存在 LV 肥厚，31-42%的女性存在向心性重构，各组之间无差异。三分之一的血压正常的既往 HELLP 患者和有或无 HELLP 的 PE 患者中存在不适当的 LVM，各组之间无差异。相应地，在没有名义差异的情况下，既往子痫前期患者的 MEEi 倾向于较低。
有 HELLP 综合征病史的妇女，无论是否存在 PE，在产后 4 年内均存在不适当的 LVM，这可能部分解释了与一般女性人群相比，这些妇女的心血管风险升高的原因。
