Division of Cardiology, Department of Medicine, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa.
Division of Cardiology, Department of Medicine, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa.
Am J Obstet Gynecol. 2022 Aug;227(2):292.e1-292.e11. doi: 10.1016/j.ajog.2022.03.009. Epub 2022 Mar 10.
Preeclampsia complicates approximately 5% of all pregnancies. When pulmonary edema occurs, it accounts for 50% of preeclampsia-related mortality. Currently, there is no consensus on the degree to which left ventricular systolic dysfunction contributes to the development of pulmonary edema.
This study aimed to use cardiac magnetic resonance imaging to detect subtle changes in left ventricular systolic function and evidence of acute left ventricular dysfunction (through tissue characterization) in women with preeclampsia complicated by pulmonary edema compared with both preeclamptic and normotensive controls.
Cases were postpartum women aged ≥18 years presenting with preeclampsia complicated by pulmonary edema. Of note, 2 control groups were recruited: women with preeclampsia without pulmonary edema and women with normotensive pregnancies. All women underwent echocardiography and 1.5T cardiac magnetic resonance imaging with native T1 and T2 mapping. Gadolinium contrast was administered to cases only. Because of small sample sizes, a nonparametric test (Kruskal-Wallis) with pairwise posthoc analysis using Bonferroni correction was used to compare the differences between the groups. Cardiac magnetic resonance images were interpreted by 2 independent reporters. The intraclass correlation coefficient was calculated to assess interobserver reliability.
Here, 20 women with preeclampsia complicated by pulmonary edema, 13 women with preeclampsia (5 with severe features and 8 without severe features), and 6 normotensive controls were recruited. There was no difference in the baseline characteristics between groups apart from the expected differences in blood pressure. Left atrial sizes were similar across all groups. Women with preeclampsia complicated by pulmonary edema had increased left ventricular mass (P=.01) but had normal systolic function compared with the normotensive controls. Furthermore, they had elevated native T1 values (P=.025) and a trend toward elevated T2 values (P=.07) in the absence of late gadolinium enhancement consistent with myocardial edema. Moreover, myocardial edema was present in all women with eclampsia or hemolysis, elevated liver enzymes, and low platelet count. Women with preeclampsia without severe features had similar findings to the normotensive controls. All cardiac magnetic resonance imaging measurements showed a very high level of interobserver correlation.
This study focused on cardiac magnetic resonance imaging in women with preeclampsia complicated by pulmonary edema, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count. We have demonstrated normal systolic function with myocardial edema in women with preeclampsia with these severe features. These findings implicate an acute myocardial process as part of this clinical syndrome. The pathogenesis of myocardial edema and its relationship to pulmonary edema require further elucidation. With normal left atrial sizes, any hemodynamic component must be acute.
子痫前期约占所有妊娠的 5%。当发生肺水肿时，它占子痫前期相关死亡的 50%。目前，对于左心室收缩功能障碍在多大程度上导致肺水肿的发生，尚无共识。
本研究旨在使用心脏磁共振成像检测子痫前期并发肺水肿患者左心室收缩功能的细微变化，并通过组织特征检测急性左心室功能障碍的证据（通过组织特征检测），与子痫前期无肺水肿和正常血压对照组进行比较。
病例为年龄≥18 岁的产后妇女，表现为子痫前期并发肺水肿。值得注意的是，招募了 2 个对照组：无肺水肿的子痫前期妇女和正常血压妊娠妇女。所有妇女均接受超声心动图和 1.5T 心脏磁共振成像检查，包括原生 T1 和 T2 映射。仅对病例给予钆造影剂。由于样本量小，使用 Kruskal-Wallis 非参数检验（具有 Bonferroni 校正的两两事后分析）比较组间差异。心脏磁共振图像由 2 位独立的报告员进行解读。计算组内相关系数以评估观察者间的可靠性。
本研究共纳入 20 例子痫前期并发肺水肿患者、13 例子痫前期患者（5 例有严重特征，8 例无严重特征）和 6 例正常血压对照组。除了血压方面的预期差异外，各组之间的基线特征没有差异。左心房大小在所有组之间相似。与正常血压对照组相比，子痫前期并发肺水肿的患者左心室质量增加（P=.01），但收缩功能正常。此外，在没有晚期钆增强的情况下，他们的原生 T1 值升高（P=.025），T2 值升高趋势（P=.07），提示存在心肌水肿。此外，所有子痫、溶血、肝酶升高和血小板减少的患者均存在心肌水肿。无严重特征的子痫前期患者的发现与正常血压对照组相似。所有心脏磁共振成像测量均显示观察者间高度相关性。
本研究重点关注子痫前期并发肺水肿、子痫、溶血、肝酶升高和血小板减少患者的心脏磁共振成像。我们已经证明，这些严重特征的子痫前期妇女存在心肌水肿，但收缩功能正常。这些发现提示急性心肌过程是这种临床综合征的一部分。心肌水肿的发病机制及其与肺水肿的关系需要进一步阐明。由于左心房大小正常，任何血液动力学成分都必须是急性的。
