Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
National Clinical Research Center of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
Acta Obstet Gynecol Scand. 2023 Nov;102(11):1566-1574. doi: 10.1111/aogs.14651. Epub 2023 Aug 2.
The primary objective of this study was to evaluate the association between maternal echocardiographic changes and the occurrence of preeclampsia (PE) in twin pregnancies. Additionally, we established and validated a prediction model for PE in twin pregnancies.
The first part of this study was retrospective and included data from 854 twin pregnancies that received antenatal care at Peking University Third Hospital from April 2017 to April 2021 (training cohort). Overall, 159 women who underwent transthoracic echocardiography were included in the analysis. To build a predictive model, cardiac findings were compared between normotensive women and those with PE. The model was then validated in a prospective longitudinal cohort (test cohort) that included 109 women with twin pregnancies who underwent two consecutive transthoracic echocardiography examinations during the second and third trimesters.
Fifty-four normotensive women and 105 women with PE were analyzed in the retrospective cohort that was used to build the model in which later preeclampsia was associated with higher left ventricular mass index (>61 g/m ), interventricular septal thickness (>7.87 mm), left atrial anteroposterior diameter (>33.5 mm), mitral inflow late diastolic velocity (A) (>0.685 m/s), ratio of early diastolic velocity (E) and peak early diastolic myocardial velocity of the lateral mitral annulus (>6.5), and lower peak early diastolic myocardial velocity (<13.1 cm/s). The optimized PE prediction model based on the interventricular septal thickness, left atrial anteroposterior diameter, A, peak early diastolic myocardial velocity and pre-pregnancy bodyweight index was then established (area under the curve [AUC] = 0.840, 95% CI 0.778-0.903, P < 0.001). The model was tested in the prospective cohort including 87 normotensive women and 22 women with PE; the validation test showed that the prediction model in the second (AUC = 0.801) and third (AUC = 0.811) trimesters had high discriminative ability and calibration.
Maternal echocardiographic changes in twin pregnancies are associated with the development of preeclampsia. The model constructed, based on the echocardiographic parameters and body mass index, provides novel ideas for the prediction of PE.
本研究的主要目的是评估母体超声心动图变化与双胎妊娠子痫前期（PE）发生之间的关系。此外，我们建立并验证了双胎妊娠 PE 的预测模型。
本研究的第一部分为回顾性研究，纳入 2017 年 4 月至 2021 年 4 月期间在北京大学第三医院接受产前检查的 854 例双胎妊娠患者（训练队列）。共有 159 名接受经胸超声心动图检查的孕妇纳入分析。为建立预测模型，比较了正常血压孕妇与 PE 孕妇的心脏表现。随后，前瞻性纵向队列（验证队列）纳入了 109 例双胎妊娠孕妇，在第二和第三个三个月期间连续进行了两次经胸超声心动图检查。
在用于建立模型的回顾性队列中，54 例正常血压孕妇和 105 例 PE 孕妇被分为两组进行分析，其中后者发生子痫前期的风险与左心室质量指数较高（>61g/m）、室间隔厚度（>7.87mm）、左心房前后径（>33.5mm）、二尖瓣口舒张晚期血流速度（A）（>0.685m/s）、E 与外侧二尖瓣环舒张早期心肌速度比值（>6.5）有关，而与舒张早期心肌速度峰值较低（<13.1cm/s）相关。基于室间隔厚度、左心房前后径、A、舒张早期心肌速度峰值和妊娠前体重指数，建立了优化的 PE 预测模型（曲线下面积[AUC]为 0.840，95%CI 为 0.778-0.903，P<0.001）。该模型在包括 87 例正常血压孕妇和 22 例 PE 孕妇的前瞻性队列中进行了测试；验证试验表明，该模型在第二个（AUC=0.801）和第三个（AUC=0.811）三个月具有较高的判别能力和校准度。
双胎妊娠母体超声心动图变化与子痫前期的发生有关。基于超声心动图参数和体重指数建立的模型为预测 PE 提供了新的思路。
