Cardiac Manifestations of Preeclampsia

先兆子痫的心脏表现

• 批准号: 10192826
• 负责人: Natalie A Bello
• 金额: $ 49.05万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-15 至 2021-09-03
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10192826
• 关键词: Affect; Ancillary Study; Angiogenic Proteins; Biological Markers; Blood Pressure; Cardiac; Cardiac health; Cardiovascular Abnormalities; Cardiovascular Diseases; Cessation of life; Child; Conceptions; Coronary; Coronary Angiography; Development; Discipline of obstetrics; Disease; Enrollment; Equation; Event; Female; Fibrosis; Funding; Future; Health Care Costs; Heart; Heart Abnormalities; Heart Diseases; Heart failure; Hypertension; Image; Incidence; Intervention; Interview; Ionizing radiation; Knowledge; Lead; Left Ventricular Function; Left Ventricular Hypertrophy; Left Ventricular Mass; Life; Longevity; Magnetic Resonance; Magnetic Resonance Imaging; Measures; Medical Records; Medical center; Methods; Microcirculation; Microvascular Dysfunction; Modeling; Modification; Monitor; Morbidity - disease rate; Mothers; Myocardial; Myocardial Infarction; Myocardial Ischemia; Myocardial perfusion; Nulliparity; Obesity; Outcome Study; Pathologic; Perinatal; Phenotype; Placenta; Play; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy Proteins; Proteins; Proteinuria; Protocols documentation; Recording of previous events; Risk; Risk Factors; Role; Site; Stress; Structure; Sustainable Development; Telephone; Testing; Time; United States National Institutes of Health; Universities; Visit; Woman; cardiovascular disorder risk; cardiovascular effects; cohort; coronary fibrosis; coronary perfusion; defined contribution; diagnostic accuracy; endothelial dysfunction; fetal; heart imaging; imaging modality; indexing; interstitial; mortality; novel; pathophysiology of preeclampsia; potential biomarker; pregnancy disorder; premature; prevent; recruit; risk sharing; risk stratification; sex; young woman

Preeclampsia, a hypertensive disorder affecting 5-8% of pregnancies, is associated with life-threatening maternal-fetal consequences and its incidence is on the rise. Long regarded as a temporary obstetrical condition with implications limited to pregnancy, it is now recognized that women with prior preeclampsia are at elevated risk for the development of sustained hypertension, premature cardiovascular disease (CVD) and a shortened lifespan. The pathophysiology of preeclampsia includes excessive placental release of anti- angiogenic proteins that lead to systemic manifestations of hypertension, proteinuria, and endothelial dysfunction. Preeclampsia is also associated with left ventricular (LV) hypertrophy and abnormal LV function, and growing body of evidence suggests that the cardiovascular abnormalities persist beyond the peripartum period. The mechanism of insult of preeclampsia’s cardiovascular effects are unknown. The central hypothesis of this proposal is that the anti-angiogenic state induced by preeclampsia increases future CVD risk by directly altering cardiac structure and function. We will employ state of the art cardiac magnetic resonance (CMR) stress imaging to quantify the coronary microcirculation and to provide deep cardiac phenotyping of the structural and functional changes after preeclampsia. We will perform a single site ancillary study in 120 women (40 with preeclampsia) followed at Columbia University in the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be Heart Health Study (nuMoM2b-HHS) to pursue the following specific aims: (1) To examine whether there are differences in the coronary microcirculation of women with a history of preeclampsia during their nuMoM2b index pregnancy compared to control women who did not have preeclampsia; (2) To determine the extent to which previous preeclampsia directly alters later cardiac structure by increasing LV mass and separately fibrosis; (3) To quantify the associations between circulating anti-angiogenic proteins of pregnancy with coronary perfusion and fibrosis 7 to 14 years after delivery. Comprehensive cardiac phenotyping of women with and without a history of preeclampsia will inform future studies examining CVD risk stratification and modification in women with a history of preeclampsia. Despite sharing many risk factors, including female predominance, obesity, and hypertension, the associations of preeclampsia with coronary microvascular disease and myocardial fibrosis have not been examined. This proposal is a crucial step towards better understanding the mechanisms through which preeclampsia alters future CVD risk in women. This knowledge will enable the development of novel, informed interventions to prevent or delay the incidence of CVD in women with a history of preeclampsia thereby decreasing premature morbidity and mortality and healthcare costs in a young and expanding subset of women.

先兆子痫是一种高血压疾病，影响 5-8% 的妊娠，可危及生命 母婴后果及其发生率正在上升。长期以来被视为临时产科 这种情况的影响仅限于怀孕，但现在人们认识到，患有先兆子痫的妇女 罹患持续性高血压、早发心血管疾病 (CVD) 和 寿命缩短。先兆子痫的病理生理学包括胎盘过度释放抗- 血管生成蛋白导致高血压、蛋白尿和内皮细胞的全身表现 功能障碍。先兆子痫还与左心室（LV）肥大和左心室功能异常有关， 越来越多的证据表明，心血管异常在围产期之后仍然存在 时期。先兆子痫损害心血管的机制尚不清楚。中心假设 该提议的主要内容是，先兆子痫诱导的抗血管生成状态会直接增加未来的 CVD 风险 改变心脏结构和功能。我们将采用最先进的心脏磁共振 (CMR) 应力成像可量化冠状动脉微循环并提供深部心脏表型分析 先兆子痫后结构和功能的变化。我们将在 120 年内进行单中心辅助研究 哥伦比亚大学对未产妇妊娠结局研究中的女性（40 名先兆子痫）进行跟踪调查 监测准妈妈心脏健康研究 (nuMoM2b-HHS) 旨在实现以下具体目标：(1) 检查有先兆子痫病史的女性的冠状动脉微循环是否存在差异 与没有先兆子痫的对照女性相比，在 nuMoM2b 指数怀孕期间； (2) 至 确定先前的先兆子痫通过增加左心室质量直接改变后来的心脏结构的程度 和单独的纤维化； (3) 量化妊娠循环抗血管生成蛋白之间的关联 产后 7 至 14 年出现冠状动脉灌注和纤维化。女性综合心脏表型分析 有或没有先兆子痫病史将为未来检查 CVD 风险分层和 对有先兆子痫病史的女性进行修改。尽管有许多共同的风险因素，包括女性 优势、肥胖和高血压，先兆子痫与冠状动脉微血管的关联 疾病和心肌纤维化尚未进行检查。该提案是迈向更好的关键一步 了解先兆子痫改变女性未来心血管疾病风险的机制。这些知识 将有助于开发新颖、知情的干预措施，以预防或延缓 CVD 的发生 有先兆子痫病史的女性，从而降低过早发病率和死亡率以及医疗保健 年轻且不断扩大的女性群体所付出的代价。