Tingyu Lan, Meng Zhang, Huiqin Zhang, Yifei Lv, Yixi Zhou, Wen He, Lijuan Du, Wei Zhang
Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Echocardiography. 2025 Sep;42(9):e70287. doi: 10.1111/echo.70287.
To evaluate the left atrial function in pregnant women with hypertension versus those with normotension using three-dimensional speckle tracking echocardiography (3D-STE) and investigate the association between left atrial dysfunction and adverse pregnancy outcomes.
A total of 94 pregnant women registered at the Tiantan Hospital between August 2023 and October 2024 who underwent comprehensive prenatal exams were enrolled. They were divided into three groups according to their blood pressure: gestational hypertension (GH), preeclampsia (PE), and normotensive control groups. The left atrial function was evaluated using two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional speckle tracking echocardiography (3D-STE). Demographic and echocardiographic parameters were analyzed and compared across the three groups. Maternal births were also documented. The primary adverse pregnancy outcomes included iatrogenic preterm delivery, admission to the neonatal intensive care unit, and infants with small for gestational age. The cohort of pregnant women with hypertensive disorders were stratified into two groups based on the occurrence of adverse pregnancy outcomes: those with adverse outcomes and those without. Comparative analyses were performed to evaluate the differences in demographic and echocardiographic parameters between these groups. Subsequently, regression analyses were performed to identify potential prognostic factors.
Pregnant women with GH and PE exhibited increased maximum left atrial volume and decreased left atrial deformation during the reservoir (LASr) and conduit (LAScd) phases compared to those in the control group (p < 0.05). 3D-STE revealed significantly larger left atrial volumes in both the GH and PE groups (p < 0.05), and compared to the control group, the absolute value of LASr, LAScd, left atrial contractile strain (LASct), and the circumferential strain of the left atrial reservoir (LASrc) demonstrated a significant reduction in the GH and PE groups (p < 0.05). Multivariate logistic regression analysis determined the systolic blood pressure and LASr (3D-STE) as independent predictors of adverse pregnancy outcomes. The LASr (3D-STE) predictive cutoff was ≤27%.
3D-STE can detect early reduced left atrial function in patients with hypertensive disorders of pregnancy, and LASr can predict adverse pregnancy outcomes.
采用三维斑点追踪超声心动图（3D-STE）评估高血压孕妇与血压正常孕妇的左心房功能，并探讨左心房功能障碍与不良妊娠结局之间的关联。
纳入2023年8月至2024年10月在天坛医院登记并接受全面产前检查的94例孕妇。根据血压将她们分为三组：妊娠期高血压（GH）组、子痫前期（PE）组和血压正常对照组。采用二维斑点追踪超声心动图（2D-STE）和三维斑点追踪超声心动图（3D-STE）评估左心房功能。分析并比较三组的人口统计学和超声心动图参数。记录产妇分娩情况。主要不良妊娠结局包括医源性早产、入住新生儿重症监护病房以及小于胎龄儿。将患有高血压疾病的孕妇队列根据不良妊娠结局的发生情况分为两组：有不良结局组和无不良结局组。进行比较分析以评估这些组之间人口统计学和超声心动图参数的差异。随后，进行回归分析以确定潜在的预后因素。
与对照组相比，GH组和PE组孕妇在储存期（LASr）和管道期（LAScd）的左心房最大容积增加，左心房变形减少（p<0.05）。3D-STE显示GH组和PE组的左心房容积均显著增大（p<0.05），与对照组相比，GH组和PE组的LASr、LAScd、左心房收缩应变（LASct）以及左心房储存期圆周应变（LASrc）的绝对值均显著降低（p<0.05）。多因素逻辑回归分析确定收缩压和LASr（3D-STE）为不良妊娠结局的独立预测因素。LASr（3D-STE）的预测临界值为≤27%。
3D-STE可检测出妊娠高血压疾病患者早期左心房功能降低，且LASr可预测不良妊娠结局。
