Low Plasma Volume and Increased Pressure Load Relate to Concentric Left Ventricular Remodeling After Preeclampsia: A Longitudinal Study.
Low Plasma Volume and Increased Pressure Load Relate to Concentric Left Ventricular Remodeling After Preeclampsia: A Longitudinal Study.
复制标题
DOI：
10.1161/jaha.119.015043
复制
发表时间：
2020-10-20
影响因子：
5.4
通讯作者：
Spaanderman MEA
中科院分区：
文献类型：
--
作者：
Breetveld NM;Alers RJ;Geerts L;van Kuijk SMJ;van Dijk AP;van der Vlugt MJ;Heidema WM;van Neer J;van Empel VPM;Brunner-La Rocca HP;Scholten RR;Ghossein-Doha C;Spaanderman MEA
在无并发症的妊娠期，左心室重构以偏心方式发生。相反，在子痫前期妊娠期间，左心室向心性肥大，同时循环容量减少和血压升高。同心心脏结构在很大比例的妇女中持续存在，可能与子痫前期的压力和容量负荷有关。我们假设低容量负荷，如子痫前期血浆容量（PV）和压力负荷增加所显示的，与远端同心重构有关。在这项纵向队列研究中，我们纳入了100名前子痫前期妇女。两次访问：在产后0.8年和产后4.8年。在访问1期间，我们测量了血压和PV （I125稀释技术，低PV≤48 mL/kg瘦体重）。在第二次就诊时，我们通过心脏超声评估心脏几何形状。同心重构定义为相对壁厚>0.42，左室质量指数≤95 g/m2。我们调整了初产、收缩压、PV mL/kg瘦体重和就诊1时抗高血压药物的多变量分析。低PV与远端同心重构相关（优势比[OR]， 4.37; 95% CI, 1.06-17.40；校正OR， 4.67; 95% CI, 1.02-21.42）。动脉压力负荷（收缩压、舒张压和平均动脉压）也与同心重构的发生有关（OR分别为1.15 [95% CI, 0.99-1.35]； OR为1.24 [95% CI, 0.98-1.58]； OR为1.20 [95% CI, 0.98-1.47]）。在前子痫前期妇女中，左心室同心重构的发展与低容量负荷和增加的压力负荷有关。
During uncomplicated pregnancy, left ventricular remodeling occurs in an eccentric way. In contrast, during preeclamptic gestation, the left ventricle hypertrophies concentrically, concurrent with loss in circulatory volume and increased blood pressure. Concentric cardiac structure persists in a substantial proportion of women and may be associated with pressure and volume load after preeclampsia. We hypothesize that low volume load, as indicated by plasma volume (PV) after preeclampsia and increased pressure load, is associated with remote concentric remodeling. In this longitudinal cohort study, we included 100 formerly preeclamptic women. Two visits were performed: at 0.8 years postpartum and at 4.8 years postpartum. During visit 1, we measured blood pressure and PV (I125 dilution technique, low PV ≤48 mL/kg lean body mass). During the second visit, we assessed cardiac geometry by cardiac ultrasound. Concentric remodeling was defined as relative wall thickness >0.42 and left ventricular mass index ≤95 g/m2. We adjusted multivariable analysis for primiparity, systolic blood pressure, PV mL/kg lean body mass, and antihypertensive medication at visit 1. Low PV is associated with remote concentric remodeling (odds ratio [OR], 4.37; 95% CI, 1.06–17.40; and adjusted OR, 4.67; 95% CI, 1.02–21.42). Arterial pressure load (systolic, diastolic, and mean arterial pressure) is also associated with development of concentric remodeling (OR, 1.15 [95% CI, 0.99–1.35]; OR, 1.24 [95% CI, 0.98–1.58]; and OR, 1.20 [95% CI, 0.98–1.47], respectively). In former preeclamptic women, development toward left ventricular concentric remodeling is associated with low volume load and increased pressure load.