Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University in St Louis, St Louis, Missouri, USA.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
J Am Coll Cardiol. 2021 Dec 7;78(23):2281-2290. doi: 10.1016/j.jacc.2021.09.1360.
BACKGROUND: Preeclampsia is associated with increased risk of future heart failure (HF), but the relationship between preeclampsia and HF subtypes are not well-established. OBJECTIVES: The objective of this analysis was to identify the risk of HF with preserved ejection fraction (HFpEF) following a delivery complicated by preeclampsia/eclampsia. METHODS: A retrospective cohort study using the New York and Florida state Healthcare Cost and Utilization Project State Inpatient Databases identified delivery hospitalizations between 2006 and 2014 for women with and without preeclampsia/eclampsia. The authors identified women admitted for HF after discharge from index delivery hospitalization until September 30, 2015, using International Classification of Diseases-9th Revision-Clinical Modification diagnosis codes. Patients were followed from discharge to the first instance of primary outcome (HFpEF hospitalization), death, or end of study period. Secondary outcomes included hospitalization for any HF and HF with reduced ejection fraction, separately. The association between preeclampsia/eclampsia and HFpEF was analyzed using Cox proportional hazards models. RESULTS: There were 2,532,515 women included in the study: 2,404,486 without and 128,029 with preeclampsia/eclampsia. HFpEF hospitalization was significantly more likely among women with preeclampsia/eclampsia, after adjusting for baseline hypertension and other covariates (aHR: 2.09; 95% CI: 1.80-2.44). Median time to onset of HFpEF was 32.2 months (interquartile range: 0.3-65.0 months), and median age at HFpEF onset was 34.0 years (interquartile range: 29.0-39.0 years). Both traditional (hypertension, diabetes mellitus) and sociodemographic (Black race, rurality, low income) risk factors were also associated with HFpEF and secondary outcomes. CONCLUSIONS: Preeclampsia/eclampsia is an independent risk factor for future hospitalizations for HFpEF.
背景:子痫前期与未来心力衰竭(HF)风险增加相关,但子痫前期与 HF 亚型之间的关系尚未得到充分确立。
目的:本分析旨在确定由子痫前期/子痫引起的分娩后射血分数保留型心力衰竭(HFpEF)的风险。
方法:一项回顾性队列研究使用纽约州和佛罗里达州医疗保健成本和利用项目州住院患者数据库,确定了 2006 年至 2014 年期间患有和未患有子痫前期/子痫的女性的分娩住院情况。作者使用国际疾病分类第 9 版临床修订诊断代码,从指数分娩住院患者出院后至 2015 年 9 月 30 日期间确定 HF 住院患者。患者从出院开始随访,直至首次出现主要结局(HFpEF 住院)、死亡或研究期末。次要结局分别包括任何 HF 和射血分数降低型 HF 的住院。使用 Cox 比例风险模型分析子痫前期/子痫与 HFpEF 的关系。
结果:共有 2532515 名女性纳入研究:2404486 名无子痫前期/子痫,128029 名有子痫前期/子痫。在校正基线高血压和其他协变量后,子痫前期/子痫患者发生 HFpEF 住院的可能性显著更高(调整后 HR:2.09;95%CI:1.80-2.44)。HFpEF 发病的中位时间为 32.2 个月(四分位距:0.3-65.0 个月),HFpEF 发病的中位年龄为 34.0 岁(四分位距:29.0-39.0 岁)。传统(高血压、糖尿病)和社会人口学(黑人种族、农村地区、低收入)风险因素也与 HFpEF 和次要结局相关。
结论:子痫前期/子痫是未来 HFpEF 住院的独立危险因素。
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