Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.
Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio.
Am J Perinatol. 2023 Aug;40(11):1163-1170. doi: 10.1055/a-2096-5114. Epub 2023 May 22.
This study aimed to evaluate rates of superimposed preeclampsia in pregnant individuals with echocardiography-diagnosed cardiac geometric changes in the setting of chronic hypertension.
This was a retrospective study of pregnant individuals with chronic hypertension who delivered singleton pregnancies at 20 weeks' gestation or greater at a tertiary care center. Analyses were limited to individuals who had an echocardiogram during any trimester. Cardiac changes were categorized as normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy according to the American Society of Echocardiography guidelines. Our primary outcome was early-onset superimposed preeclampsia defined as delivery at less than 34 weeks' gestation. Other secondary outcomes were also examined. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for prespecified covariates.
Of the 168 individuals who delivered from 2010 to 2020, 57 (33.9%) had normal morphology, 54 (32.1%) had concentric remodeling, 9 (5.4%) had eccentric hypertrophy, and 48 (28.6%) had concentric hypertrophy. Non-Hispanic black individuals presented over 76% of the cohort. Rates of the primary outcome in individuals with normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were 15.8, 37.0, 22.2, and 41.7%, respectively ( = 0.01). Compared with individuals with normal morphology, individuals with concentric remodeling were more likely to have the primary outcome (aOR: 3.28; 95% CI: 1.28-8.39), fetal growth restriction (crude OR: 2.98; 95% CI: 1.05-8.43), and iatrogenic preterm delivery <34 weeks' gestation (aOR: 2.72; 95% CI: 1.15-6.40). Compared with individuals with normal morphology, individuals with concentric hypertrophy were more likely to have the primary outcome (aOR: 4.16; 95% CI: 1.57-10.97), superimposed preeclampsia with severe features at any gestational age (aOR: 4.75; 95% CI: 1.94-11.62), iatrogenic preterm delivery <34 weeks' gestation (aOR: 3.60; 95% CI: 1.47-8.81), and neonatal intensive care unit admission (aOR: 4.82; 95% CI: 1.90-12.21).
Concentric remodeling and concentric hypertrophy were associated with increased odds of early-onset superimposed preeclampsia.
· Concentric remodeling and concentric hypertrophy were associated with an increased risk of superimposed preeclampsia.. · Concentric hypertrophy was associated with an increased risk of delivery at less than 34 weeks.. · Two-thirds of the individuals in our study had concentric hypertrophy and concentric remodeling..
本研究旨在评估在慢性高血压患者中，经超声心动图诊断为心脏几何结构改变的情况下，并发子痫前期的发生率。
这是一项回顾性研究，纳入在三级医疗中心分娩的单胎妊娠且妊娠 20 周或以上的慢性高血压孕妇。分析仅限于在任何孕早期进行超声心动图检查的个体。根据美国超声心动图学会指南，心脏改变分为正常形态、向心性重构、离心性肥厚和向心性肥厚。我们的主要结局是早发型并发子痫前期，定义为妊娠 34 周前分娩。还检查了其他次要结局。使用 95%置信区间（95%CI）的调整比值比（aOR）进行计算，控制了预设协变量。
在 2010 年至 2020 年分娩的 168 名患者中，57 名（33.9%）为正常形态，54 名（32.1%）为向心性重构，9 名（5.4%）为离心性肥厚，48 名（28.6%）为向心性肥厚。非西班牙裔黑人占队列的 76%以上。正常形态、向心性重构、离心性肥厚和向心性肥厚患者的主要结局发生率分别为 15.8%、37.0%、22.2%和 41.7%（=0.01）。与正常形态患者相比，向心性重构患者更有可能出现主要结局（aOR：3.28；95%CI：1.28-8.39）、胎儿生长受限（粗 OR：2.98；95%CI：1.05-8.43）和医源性早产（妊娠 34 周前，aOR：2.72；95%CI：1.15-6.40）。与正常形态患者相比，向心性肥厚患者更有可能出现主要结局（aOR：4.16；95%CI：1.57-10.97）、任何孕龄并发子痫前期伴严重特征（aOR：4.75；95%CI：1.94-11.62）、医源性早产（妊娠 34 周前，aOR：3.60；95%CI：1.47-8.81）和新生儿重症监护病房入住（aOR：4.82；95%CI：1.90-12.21）。
向心性重构和向心性肥厚与早发型并发子痫前期的发生风险增加有关。
