Olsen Ása Wraae, Sørensen Anne Nødgaard Weidemann, Rathcke Sidsel Linneberg, Christensen Trine Tang, Frøkjær Jens Brøndum, Søgaard Peter, Zaremba Tomas
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.
Open Heart. 2025 Sep 5;12(2):e003427. doi: 10.1136/openhrt-2025-003427.
Evidence regarding cardiovascular adaptation to pregnancy in women with pregestational diabetes is limited. Our study aimed to describe left ventricular (LV) remodelling and vascular adaptation to pregnancy in women with type 1 diabetes.
In this prospective cohort study, three consecutive cardiac MRI scans were conducted on age-matched and BMI-matched pregnant women with pregestational type 1 diabetes and pregnant women without diabetes. The scans were performed at gestational weeks 15-20, 26-30 and 34-37 from November 2020 to April 2023. Data collection and analysis included LV imaging results, brachial blood pressure and stroke volume derived functional vascular parameters.
The study included 24 women with pregestational type 1 diabetes and 39 controls. Compared with controls, women with type 1 diabetes had significantly reduced LV end-diastolic volume index: 64.2±11.1 mL/m vs 77.6±13.9 mL/m (p<0.001), reduced end-systolic volume index: 26.0±7.3 mL/m vs 33.5±7.7 mL/m (p=0.003), increased concentricity: 0.84±0.13 g/mL vs 0.68±0.10 g/mL (p<0.001), reduced stroke volume index: 38.2±7.2 mL/m vs 44.1±8.4 mL/m (p=0.008), reduced cardiac index: 3.37±0.55 L/min/m vs 3.62±0.51 L/min/m (p=0.046), reduced global longitudinal strain: -13.5±2.3% vs -15.2±2.1% (p=0.04), increased myocardial T1 values: 998±28 ms vs 983±25 ms (p=0.03), increased systolic blood pressure: 128.1±7.8 mmHg vs 117.4±11.1 mmHg (p=0.007), increased mean arterial pressure: 94.8±6.7 mmHg vs 88.1±9.7 mmHg (p=0.03), increased total peripheral vascular resistance: 28.9±5.3 mmHg·min·m/L vs 24.7±4.0 mmHg·min·m/L (p=0.001), and reduced total arterial compliance: 0.79±0.19 mL/m/mmHg vs 1.02±0.21 mL/m/mmHg (p<0.001).
Our study provides evidence of impaired LV remodelling and suboptimal vascular adaptation to pregnancy in women with type 1 diabetes when compared to women without diabetes. The clinical implications of these findings, particularly their association with the development of later cardiovascular disease, require further investigation.
关于孕前糖尿病女性心血管系统对妊娠适应情况的证据有限。我们的研究旨在描述1型糖尿病女性的左心室（LV）重塑及血管对妊娠的适应情况。
在这项前瞻性队列研究中，对年龄和体重指数匹配的孕前1型糖尿病孕妇及非糖尿病孕妇连续进行了三次心脏磁共振成像扫描。扫描于2020年11月至2023年4月在妊娠第15 - 20周、26 - 30周和34 - 37周进行。数据收集与分析包括左心室成像结果、肱动脉血压及每搏输出量衍生的功能性血管参数。
该研究纳入了24例孕前1型糖尿病女性和39例对照者。与对照组相比，1型糖尿病女性的左心室舒张末期容积指数显著降低：64.2±11.1 mL/m 对 77.6±13.9 mL/m（p<0.001），收缩末期容积指数降低：26.0±7.3 mL/m 对 33.5±7.7 mL/m（p = 0.003），同心性增加：0.84±0.13 g/mL 对 0.68±0.10 g/mL（p<0.001），每搏输出量指数降低：38.2±7.2 mL/m 对 44.1±8.4 mL/m（p = 0.008），心脏指数降低：3.37±0.55 L/min/m 对 3.62±0.51 L/min/m（p = 0.046），整体纵向应变降低：-13.5±2.3% 对 -15.2±2.1%（p = 0.04），心肌T1值增加：998±28 ms 对 983±25 ms（p = 0.03），收缩压升高：128.1±7.8 mmHg 对 117.4±11.1 mmHg（p = 0.007），平均动脉压升高：94.8±6.7 mmHg 对 88.1±9.7 mmHg（p = 0.03），总外周血管阻力增加：28.9±5.3 mmHg·min·m/L 对 24.7±4.0 mmHg·min·m/L（p = 0.001），总动脉顺应性降低：0.79±0.19 mL/m/mmHg 对 1.02±0.21 mL/m/mmHg（p<0.001）。
我们的研究表明，与非糖尿病女性相比，1型糖尿病女性存在左心室重塑受损及血管对妊娠适应欠佳的情况。这些发现的临床意义，尤其是它们与后期心血管疾病发生的关联，需要进一步研究。
