Kim Hyungseop, Bae Jin-Gon, Lee Hee-Jeong, Lee Seonhwa, Kim In-Cheol
Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
J Echocardiogr. 2025 Jan 5. doi: 10.1007/s12574-024-00679-3.
With the growing number of high-risk pregnant women, echocardiography frequently reveals pericardial effusion (PE). However, the clinical implications of PE are unknown.
We analyzed a cohort of 406 high-risk pregnant women who underwent echocardiography in the third trimester between November 2019 and December 2022. The association between PE and clinical outcomes was assessed: the primary endpoint was the occurrence of preeclampsia, and the secondary composite outcomes were defined as the occurrence of preeclampsia, heart failure (HF), and pleural effusion within three months after birth.
Of the 406 high-risk pregnant women, 99 (24.4%) had PE. Women with PE were more likely to be younger, have higher blood pressure and soluble suppression of tumorigenicity-2, and develop gestational diabetes mellitus. They had increased left atrial and ventricular volumes, a higher mitral inflow, a lower systolic tissue velocity of the septal mitral annulus, a higher E/e' ratio and pulmonary artery systolic pressure, and a higher frequency of ≥ mild to moderate mitral/tricuspid regurgitation. PE was mainly associated with gestational hypertension. During follow-up, preeclampsia, HF, isolated pleural effusion, and any composite outcome were significantly more prevalent in women with PE. In multivariate analysis, PE was the most significant factor for adverse composite outcomes.
In high-risk pregnant women, PE during the third trimester may be a novel biomarker for preeclampsia and peripartum HF. The timely implementation of echocardiographic surveillance during the third trimester in high-risk pregnant women may be helpful for the earlier recognition of PE, preeclampsia, and HF.
随着高危孕妇数量的增加，超声心动图经常显示心包积液（PE）。然而，PE的临床意义尚不清楚。
我们分析了2019年11月至2022年12月期间在孕晚期接受超声心动图检查的406例高危孕妇队列。评估了PE与临床结局之间的关联：主要终点是子痫前期的发生，次要复合结局定义为产后三个月内子痫前期、心力衰竭（HF）和胸腔积液的发生。
在406例高危孕妇中，99例（24.4%）有PE。有PE的女性更可能年轻，血压和可溶性肿瘤抑制因子-2水平更高，并发妊娠期糖尿病。她们的左心房和心室容积增加，二尖瓣血流增加，二尖瓣间隔环收缩期组织速度降低，E/e'比值和肺动脉收缩压升高，二尖瓣/三尖瓣反流≥轻度至中度的频率更高。PE主要与妊娠期高血压相关。在随访期间，子痫前期、HF、单纯胸腔积液和任何复合结局在有PE的女性中明显更普遍。在多变量分析中，PE是不良复合结局的最显著因素。
在高危孕妇中，孕晚期的PE可能是子痫前期和围产期HF的一种新的生物标志物。在高危孕妇孕晚期及时进行超声心动图监测可能有助于更早识别PE、子痫前期和HF。
