Cardiology Division, Department of Medicine, Massachusetts General Hospital (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.), Harvard Medical School, Boston.
Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (M.C.H., P.N.).
Hypertension. 2024 Jun;81(6):1272-1284. doi: 10.1161/HYPERTENSIONAHA.124.22905. Epub 2024 Apr 2.
Preeclampsia is a pregnancy-specific hypertensive disorder associated with an imbalance in circulating proangiogenic and antiangiogenic proteins. Preclinical evidence implicates microvascular dysfunction as a potential mediator of preeclampsia-associated cardiovascular risk.
Women with singleton pregnancies complicated by severe antepartum-onset preeclampsia and a comparator group with normotensive deliveries underwent cardiac positron emission tomography within 4 weeks of delivery. A control group of premenopausal, nonpostpartum women was also included. Myocardial flow reserve, myocardial blood flow, and coronary vascular resistance were compared across groups. sFlt-1 (soluble fms-like tyrosine kinase receptor-1) and PlGF (placental growth factor) were measured at imaging.
The primary cohort included 19 women with severe preeclampsia (imaged at a mean of 15.3 days postpartum), 5 with normotensive pregnancy (mean, 14.4 days postpartum), and 13 nonpostpartum female controls. Preeclampsia was associated with lower myocardial flow reserve (β, -0.67 [95% CI, -1.21 to -0.13]; =0.016), lower stress myocardial blood flow (β, -0.68 [95% CI, -1.07 to -0.29] mL/min per g; =0.001), and higher stress coronary vascular resistance (β, +12.4 [95% CI, 6.0 to 18.7] mm Hg/mL per min/g; =0.001) versus nonpostpartum controls. Myocardial flow reserve and coronary vascular resistance after normotensive pregnancy were intermediate between preeclamptic and nonpostpartum groups. Following preeclampsia, myocardial flow reserve was positively associated with time following delivery (=0.008). The sFlt-1/PlGF ratio strongly correlated with rest myocardial blood flow (=0.71; <0.001), independent of hemodynamics.
In this exploratory cross-sectional study, we observed reduced coronary microvascular function in the early postpartum period following preeclampsia, suggesting that systemic microvascular dysfunction in preeclampsia involves coronary microcirculation. Further research is needed to establish interventions to mitigate the risk of preeclampsia-associated cardiovascular disease.
子痫前期是一种与循环中促血管生成和抗血管生成蛋白失衡相关的妊娠特异性高血压疾病。临床前证据表明微血管功能障碍可能是子痫前期相关心血管风险的潜在介导因素。
患有严重产前起病子痫前期的单胎妊娠妇女和血压正常分娩的对照组妇女在分娩后 4 周内行心脏正电子发射断层扫描。还纳入了一组绝经前、非产后的女性作为对照组。比较各组间的心肌血流储备、心肌血流和冠状动脉血管阻力。在成像时测量 sFlt-1（可溶性 fms 样酪氨酸激酶受体-1）和 PlGF（胎盘生长因子）。
主要队列包括 19 例严重子痫前期妇女（产后平均 15.3 天进行成像）、5 例血压正常妊娠妇女（产后平均 14.4 天进行成像）和 13 例非产后女性对照组。与非产后对照组相比，子痫前期患者的心肌血流储备较低（β=-0.67[95%CI，-1.21 至-0.13]；=0.016）、应激时心肌血流较低（β=-0.68[95%CI，-1.07 至-0.29]mL/min/g；=0.001）和应激时冠状动脉血管阻力较高（β=+12.4[95%CI，6.0 至 18.7]mmHg/mL/min/g；=0.001）。正常妊娠后的心肌血流储备和冠状动脉血管阻力在子痫前期和非产后组之间处于中间位置。子痫前期后，心肌血流储备与产后时间呈正相关（=0.008）。sFlt-1/PlGF 比值与静息心肌血流密切相关（=0.71；<0.001），与血液动力学无关。
在这项探索性的横断面研究中，我们观察到子痫前期后早期产后冠状动脉微血管功能降低，表明子痫前期中的全身微血管功能障碍涉及冠状动脉微循环。需要进一步的研究来确定减轻子痫前期相关心血管疾病风险的干预措施。
