Cardiovascular System During the Postpartum State in Women With a History of Preeclampsia
Cardiovascular System During the Postpartum State in Women With a History of Preeclampsia
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DOI：
10.1161/hypertensionaha.111.173278
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发表时间：
2011-07-01
期刊：
影响因子：
8.3
通讯作者：
Shroff, Sanjeev G.
中科院分区：
文献类型：
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作者：
Evans, Caroline S.;Gooch, Linda;Shroff, Sanjeev G.
在既往患有先兆子痫的受试者中，非妊娠状态下存在心血管和/或血液生化参数的差异，并且同时评估多个衍生指标可以更好地区分患有或不患有先兆子痫的女性。我们检查了 18 例先兆子痫和 50 例无并发症的妊娠，时间大约为产后 16 个月。心血管评估包括以下内容：（1）全身血流动力学和力学（多普勒超声心动图、张力测量和示波血压测量）； (2)内皮功能（体积描记法）； (3) 左心室特性（超声心动图）； (4)血液生化分析。与既往无并发症妊娠的女性相比，既往先兆子痫患者的平均压（80 +/- 1 对比 86 +/- 3 毫米汞柱；P=0.04）和舒张压（64 +/- 1 对比 68 +/- 2 毫米汞柱；P=0.04）和总血管阻力（1562 +/- 37 对比 1784 +/- 114 达因）较高。秒/厘米(5)； P=0.03）。收缩压、动脉顺应性和左心室特性没有差异。尽管心脏到股骨的脉搏波速度没有差异，但在既往先兆子痫中，心脏到肱骨的脉搏波速度往往更快（374 +/- 8 vs 404 +/- 20 cm/s；P=0.06）。在既往先兆子痫患者中，压力引起的前臂血流量增加较少（245%+/- 21% 对比 136%+/- 22%；P=0.01），表明内皮功能受损。内皮激活、血脂异常或氧化应激标志物没有观察到显着差异；既往先兆子痫患者的血糖水平往往较高（58.7 +/- 1.9 vs 95 +/- 5.2 mg/dL；P=0.06）。逻辑回归分析表明，同时评估多个派生指数可以更好地区分两组。先前先兆子痫组的差异与日后更大的心血管疾病风险相关。 （高血压。2011；58：57-62。）。在线数据补充
In subjects with previous preeclampsia, differences in cardiovascular and/or blood biochemical parameters are present in the nonpregnant state, and a simultaneous assessment of multiple derived indices better differentiates between women with or without previous preeclampsia. We examined 18 previous preeclamptic and 50 previous uncomplicated pregnancies, approximate to 16 months postpartum. Cardiovascular assessment included the following: (1) systemic hemodynamics and mechanics (Doppler echocardiography, tonometry, and oscillometric sphygmomanometry); (2) endothelial function (plethysmography); (3) left ventricular properties (echocardiography); and (4) blood biochemical analyses. Compared to women with previous uncomplicated pregnancies, previous preeclamptics had higher mean (80 +/- 1 versus 86 +/- 3 mm Hg; P=0.04) and diastolic (64 +/- 1 versus 68 +/- 2 mm Hg; P=0.04) pressures and total vascular resistance (1562 +/- 37 versus 1784 +/- 114 dyne . s/cm(5); P=0.03). Systolic blood pressure, arterial compliance, and left ventricular properties were not different. Although heart-to-femoral pulse wave velocity was not different, heart-to-brachial pulse wave velocity tended to be faster in previous preeclamptics (374 +/- 8 versus 404 +/- 20 cm/s; P=0.06). Stress-induced increase in forearm blood flow was less in previous preeclamptics (245%+/- 21% versus 136%+/- 22%; P=0.01), indicating impaired endothelial function. No significant differences were observed in markers of endothelial activation, dyslipidemia, or oxidative stress; previous preeclamptics tended to have higher glucose level (58.7 +/- 1.9 versus 95 +/- 5.2 mg/dL; P=0.06). Logistic regression analysis indicated that a simultaneous evaluation of multiple derived indices better discriminated between the 2 groups. The differences in the previous preeclamptic group are in directions known to be associated with greater cardiovascular disease risk later in life. (Hypertension. 2011;58:57-62.). Online Data Supplement