Long-Term Cardiac Function After Peripartum Cardiomyopathy and Preeclampsia: A Danish Nationwide, Clinical Follow-Up Study Using Maximal Exercise Testing and Cardiac Magnetic Resonance Imaging.
Long-Term Cardiac Function After Peripartum Cardiomyopathy and Preeclampsia: A Danish Nationwide, Clinical Follow-Up Study Using Maximal Exercise Testing and Cardiac Magnetic Resonance Imaging.
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周围心肌病和先兆子痫后的长期心脏功能：丹麦全国性的临床随访研究，使用最大运动测试和心脏磁共振成像。
DOI：
10.1161/jaha.118.008991
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发表时间：
2018-10-16
影响因子：
5.4
通讯作者：
Vejlstrup NG
中科院分区：
文献类型：
--
作者：
Ersbøll AS;Bojer AS;Hauge MG;Johansen M;Damm P;Gustafsson F;Vejlstrup NG
围产期心肌病（PPCM）的长期临床研究很少。我们的目的是衡量 PPCM 对心功能的长期影响，并与严重先兆子痫和无并发症妊娠的长期影响进行比较。 2005年至2014年丹麦全国范围内诊断患有PPCM的女性队列（PPCM组）被邀请参加一项临床随访研究，包括最大心肺运动测试和心脏磁共振成像。将既往患有严重子痫前期（子痫前期组）和既往无并发症妊娠（无并发症妊娠组）的匹配女性作为对照组。共有 84 名女性参加，每组 28 名。 PPCM 后的中位随访时间为 91 个月。 PPCM 组中的大多数女性（85%）报告没有心力衰竭症状。 PPCM组的平均左心室射血分数正常为62%，但显着低于先兆子痫组和无并发症妊娠组的平均左心室射血分数分别为69%和67%（P<0.0001）。 PPCM 组的女性舒张功能也受损，左心室峰值充盈率、左心房被动排空量和左心房被动排空分数降低。与先兆子痫组和无并发症妊娠组相比，PPCM 组的最大运动能力（峰值 VO 2）也降低，并且 PPCM、高体重指数和低左心室射血分数独立预测峰值 VO 2 降低。只有 1 名 PPCM 女性出现晚期钆增强。女性一般会在 PPCM 后 7 年恢复左心室射血分数且无症状，但心脏磁共振成像显示轻微的舒张功能障碍，并且峰值 VO 2 降低。然而，用晚期钆增强评估的局灶性心肌纤维化并不常见。
Long‐term clinical studies of peripartum cardiomyopathy (PPCM) are few. We aimed to measure the long‐term effect of PPCM on cardiac function in comparison with the long‐term effects of severe preeclampsia and uncomplicated pregnancy. A nationwide Danish cohort of women diagnosed with PPCM from 2005 to 2014 (PPCMgroup) were invited to participate in a clinical follow‐up study including maximal cardiopulmonary exercise testing and cardiac magnetic resonance imaging. Matched women with previous severe preeclampsia (preeclampsia group) and previous uncomplicated pregnancies (uncomplicated pregnancies group) served as comparison groups. A total of 84 women with 28 in each group participated. Median time to follow‐up after PPCM was 91 months. Most women (85%) in the PPCM group reported no symptoms of heart failure. Mean left ventricular ejection fraction in the PPCM group was normal at 62%, but significantly lower than in the preeclampsia group and the uncomplicated pregnancies group where mean left ventricular ejection fraction was 69% and 67%, respectively (P<0.0001). Women in the PPCM group also had impaired diastolic function with reduced left ventricular peak filling rate, left atrial passive emptying volume, and left atrial passive emptying fraction. Maximal exercise capacity (peak VO 2) was also reduced in the PPCM group compared with the preeclampsia group and the uncomplicated pregnancies group, and PPCM, high body mass index, and low left ventricular ejection fraction independently predicted reduced peak VO 2. Only 1 woman with PPCM had late gadolinium enhancement. Women generally recovered left ventricular ejection fraction and were asymptomatic 7 years after PPCM, but had subtle diastolic dysfunction on cardiac magnetic resonance imaging and reduced peak VO 2. Focal myocardial fibrosis assessed with late gadolinium enhancement was, however, uncommon.