Decreased endothelial function and increased subclinical heart failure in women several years after pre-eclampsia
Decreased endothelial function and increased subclinical heart failure in women several years after pre-eclampsia
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DOI：
10.1002/uog.17534
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发表时间：
2018-08-01
影响因子：
7.1
通讯作者：
Spaanderman, M. E. A.
中科院分区：
文献类型：
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作者：
Breetveld, N. M.;Ghossein-Doha, C.;Spaanderman, M. E. A.
目的子痫前期(PE)既与产后内皮功能障碍有关，又与心力衰竭B期(HF-B)的无症状心脏结构改变相关。在这项研究中，我们评估了血流介导的扩张(FMD)测量的内皮功能与有PE病史的妇女HF-B之间的关系。方法对67例有子痫前期史的妇女(产后4年)和37名健康产妇进行了超声心动图检查，测量心脏功能和几何构型，并用臂动脉FMD检测内皮功能。HF-B诊断为左室肥厚(左心室重量指数(LVMi)和Gt；95g/m(2))、向心性重构(相对室壁厚度和LVMi分别为0.42和40%和55%)或无症状瓣膜病。心血管和代谢综合征变量在有PE病史的妇女和对照组之间进行比较，以及在有心力衰竭A期、心力衰竭-B期或无心力衰竭的先兆子痫组之间进行比较。结果先兆子痫妇女的HF-B患病率是对照组的三倍(25%比8%，P<；0.05)，而先兆子痫妇女的FMD比对照组低(6.12%比8.22%，P<；0.01)；在调整代谢综合征危险因素和产科参数后，PE病史与较低的FMD独立相关(β，-1.88；95%可信区间，-3.59~-0.18)。结论妊娠数年后，先兆子痫妇女的FMD较低，与正常产妇相比，Hf-B的患病率较高。尽管如此，HF-B与FMD降低无关。版权所有c(C)2017 ISUOG。由John Wiley&Sons Ltd.出版。
Objectives Pre-eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure Stage B (HF-B). In this study, we assessed the relationship between endothelial function, measured by flow-mediated dilation (FMD), and HF-B in women with a history of PE.Methods This was an observational study in which 67 formerly pre-eclamptic women (>= 4 years postpartum) and 37 healthy parous controls were assessed ultrasonographically for cardiac function and geometry, as well as for endothelial function by means of brachial artery FMD. HF-B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) > 95 g/m(2)), concentric remodeling (relative wall thickness> 0.42 and LVMi 40% and < 55%) or asymptomatic valvular disease. Cardiovascular and metabolic syndrome variables were compared between women with history of PE and controls, as well as between those in the formerly pre-eclamptic group who had HF Stage A, HF-B or no HF. Logistic regression analysis was performed to assess the associations of FMD with PE, metabolic syndrome risk factors and obstetric parameters.Results The prevalence of HF-B amongst formerly pre-eclamptic women was three-fold higher than that observed for controls (25% vs 8%, P < 0.05), while FMD was lower in formerly pre-eclamptic women compared with controls (6.12% vs 8.22%, P < 0.01); history of PE remained associated independently with lower FMD after adjusting for metabolic syndrome risk factors and obstetric parameters (beta, -1.88; 95% CI, -3.59 to -0.18). However, HF-B did not relate to low FMD in formerly pre-eclamptic women.Conclusions Years after pregnancy, formerly preeclamptic women have lower FMD and have HF-B more often compared with healthy parous controls. Nonetheless, HF-B was not related to reduced FMD. Copyright c (C) 2017 ISUOG. Published by John Wiley & Sons Ltd.