Cardiac diastolic function after recovery from pre-eclampsia.
Cardiac diastolic function after recovery from pre-eclampsia.
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DOI：
10.5830/cvja-2017-031
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发表时间：
2018
影响因子：
0.7
通讯作者：
Pattinson RC
中科院分区：
文献类型：
--
作者：
Soma-Pillay P;Louw MC;Adeyemo AO;Makin J;Pattinson RC
先兆子痫与怀孕期间心血管系统的显著变化有关。左心室发生离心和同心重塑，导致收缩力受损和舒张功能障碍。目前尚不清楚这些结构和功能变化是否在分娩后完全消退。这项研究的目的是确定严重先兆子痫妇女分娩时和产后一年的心脏舒张功能，并确定未来可能的心血管风险。这是一项在南非比勒陀利亚三级转诊医院Steve Biko Academic Hospital进行的描述性研究。96名重度子痫前期妇女和45名血压正常的无并发症妊娠妇女在分娩入院时被招募。先兆子痫组中有74例（77.1%）妇女被归类为母亲未遂。在分娩时和产后一年进行经胸多普勒超声心动图检查。在产后一年，先兆子痫妇女的舒张压（p = 0.001）和体重指数（p = 0.02）高于血压正常的对照组。妊娠34周前分娩的早发性先兆子痫妇女在产后1年时舒张功能障碍的风险增加（RR 3.41，95% CI：1.11-10.5，p = 0.04），这与患者是否患有慢性高血压无关。与有低风险妊娠史的血压正常的妇女相比，在34周前发生早发性先兆子痫需要分娩的妇女在分娩后一年发生心脏舒张功能障碍的风险很大。
Pre-eclampsia is associated with significant changes to the cardiovascular system during pregnancy. Eccentric and concentric remodelling of the left ventricle occurs, resulting in impaired contractility and diastolic dysfunction. It is unclear whether these structural and functional changes resolve completely after delivery. The objective of the study was to determine cardiac diastolic function at delivery and one year post-partum in women with severe pre-eclampsia, and to determine possible future cardiovascular risk. This was a descriptive study performed at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. Ninety-six women with severe preeclampsia and 45 normotensive women with uncomplicated pregnancies were recruited during the delivery admission. Seventy-four (77.1%) women in the pre-eclamptic group were classified as a maternal near miss. Transthoracic Doppler echocardiography was performed at delivery and one year post-partum. At one year post-partum, women with pre-eclampsia had a higher diastolic blood pressure (p = 0.001) and body mass index (p = 0.02) than women in the normotensive control group. Women with early onset pre-eclampsia requiring delivery prior to 34 weeks’ gestation had an increased risk of diastolic dysfunction at one year post-partum (RR 3.41, 95% CI: 1.11–10.5, p = 0.04) and this was irrespective of whether the patient had chronic hypertension or not. Women who develop early-onset pre-eclampsia requiring delivery before 34 weeks are at a significant risk of developing cardiac diastolic dysfunction one year after delivery compared to normotensive women with a history of a low-risk pregnancy.