Harris Birthright Research Centre for Fetal Medicine, King's College London, London, United Kingdom.
Institute of Health Research, University of Exeter, Exeter, United Kingdom.
J Am Coll Cardiol. 2022 Jan 4;79(1):52-62. doi: 10.1016/j.jacc.2021.10.033.
Preeclampsia (PE) is an independent risk factor for adverse maternal cardiovascular outcomes. The role of maternal cardiac function in the pathophysiology of PE remains unclear.
This study sought to describe differences in cardiac function at midgestation between women who develop PE and those with uncomplicated pregnancy and to establish whether routine cardiac assessment at midgestation can improve performance of screening for PE achieved by established biomarkers.
Mean arterial pressure was measured, medical history was obtained, and left ventricular (LV) systolic and diastolic functions were assessed using standard echocardiography and speckle tracking imaging. Uterine artery pulsatility index and serum placental growth factor and soluble fms-like tyrosine kinase-1 were measured.
In 4,795 pregnancies, 126 (2.6%) developed PE. Following multivariable analysis, peripheral vascular resistance was significantly higher and LV global longitudinal systolic strain, ejection fraction, cardiac output, and left atrial area were mildly lower in women who developed PE compared to those who did not. There was a weak association between maternal cardiovascular indices and biomarkers of placental perfusion and function. Cardiac indices did not improve the performance of screening for PE on top of maternal risk factors, mean arterial pressure, and biomarkers of placental perfusion and function.
Women who develop PE have an increase in peripheral vascular resistance and a mild reduction in LV functional cardiac indices long before PE development. However, cardiac indices do not improve the performance of screening for PE; thus, their routine clinical use is not advocated.
子痫前期 (PE) 是不良母婴心血管结局的独立危险因素。母体心脏功能在 PE 的病理生理学中的作用尚不清楚。
本研究旨在描述在妊娠中期，发生 PE 的女性与无并发症妊娠的女性之间心脏功能的差异，并确定在妊娠中期进行常规心脏评估是否可以提高通过已建立的生物标志物进行的 PE 筛查的性能。
测量平均动脉压，获取病史，并使用标准超声心动图和斑点追踪成像评估左心室 (LV) 收缩和舒张功能。测量子宫动脉搏动指数和血清胎盘生长因子和可溶性 fms 样酪氨酸激酶-1。
在 4795 例妊娠中，有 126 例 (2.6%) 发生了 PE。经过多变量分析，与未发生 PE 的女性相比，发生 PE 的女性外周血管阻力明显升高，LV 整体纵向收缩应变、射血分数、心输出量和左心房面积略低。母体心血管指数与胎盘灌注和功能的生物标志物之间存在弱相关性。心脏指数并未在母体危险因素、平均动脉压和胎盘灌注及功能的生物标志物的基础上提高 PE 筛查的性能。
发生 PE 的女性在发生 PE 之前很早就出现外周血管阻力增加和 LV 功能心脏指数轻度降低。然而，心脏指数并不能提高 PE 筛查的性能；因此，不提倡常规临床使用。
