Subclinical cardiac dysfunction after hypertensive disorders in pregnancy

妊娠期高血压疾病后的亚临床心功能不全

• 批准号: 10002116
• 负责人: CAREY FARQUHAR
• 金额: $ 14.06万
• 依托单位: UNIVERSITY OF NAIROBI
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-06 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10002116
• 关键词: Address; Adult; Africa South of the Sahara; Biological Markers; Blood Pressure; C-reactive protein; Cardiac; Cardiovascular Diseases; Cause of Death; Cessation of life; Chronic; Clinical Research; Development; Disease; Disease Outcome; EFRAC; Early identification; Echocardiography; Evaluation; Exploratory/Developmental Grant for Diagnostic Cancer Imaging; Female; Future; Heart; Heart Injuries; Heart failure; High Risk Woman; Income; Inflammation; Inflammatory; Interleukin-1; Intervention; Kenya; Maternal Health; Measurement; Measures; Mechanics; Metabolic Diseases; Metabolic syndrome; Monitor; Myocardial; Myocardial Ischemia; Myocardial dysfunction; Outcome; Patients; Perinatal; Populations at Risk; Postpartum Period; Postpartum Women; Pre-Eclampsia; Pregnancy; Prevalence; Preventive Intervention; Prognostic Marker; Prospective cohort study; Public Health; Reporting; Research; Research Infrastructure; Risk; Risk Factors; Serum; Stress; Stroke; Two-Dimensional Echocardiography; Universities; Washington; Woman; adverse outcome; burden of illness; cardiometabolism; cardiovascular disorder risk; cardiovascular risk factor; end stage disease; experience; heart function; heart imaging; hemodynamics; imaging biomarker; immune activation; inflammatory marker; low and middle-income countries; mortality; novel; outcome forecast; pregnancy disorder; pregnancy hypertension; preservation; prevent; screening

7. ABSTRACT Cardiovascular disease (CVD) remains the leading cause of mortality globally. About three quarters of CVD deaths occur in the low- and middle-income settings. Although CVD related deaths have progressively declined in high income settings, mortality among adults below 55 years especially women have stagnated, most likely due to female specific risk factors. One such factor, new onset hypertensive disorders of pregnancy (HDP) is associated with 2-fold or greater risk for future metabolic syndrome, chronic low-grade inflammation and heart failure. However, majority of studies on long-term heart failure risk after HDP have mostly focused on end-stage disease and not the progression of asymptomatic cardiac dysfunction. Previous studies have shown that even the asymptomatic patients with myocardial dysfunction have compromised prognosis with an increased risk of developing symptomatic heart failure in the future. Therefore, early identification of at-risk population of women is critical and would allow implementation of intervention strategies to delay the progression or to prevent the onset of heart failure. Few studies in high income settings and none in SSA have evaluated the risk and correlates of subclinical cardiac dysfunction after HDP using speckle tracking echocardiography (STE) which accurately quantifies myocardial mechanics, including global longitudinal strain (GLS), a prognostic marker of adverse CVD outcomes. Using STE, we aim to understand and describe the presence and progression of asymptomatic cardiac dysfunction after pregnancies complicated with HDP (Aim 1) and evaluate the contribution of inflammation at 3 years postpartum by comparing women with and without new onset of new hypertensive disorders of pregnancy (Aims 2 and 3). The study findings will inform the development of novel and scalable screening and monitoring strategies to manage CVD risk after HDP and therefore reduce CVD and CVD- mortality in sub-Saharan Africa and globally.

7.摘要 心血管疾病（CVD）仍然是全球死亡的主要原因。大约四分之三的CVD 死亡发生在低收入和中等收入环境中。尽管CVD相关死亡率逐渐下降， 在高收入环境中，55岁以下成年人特别是妇女的死亡率很可能停滞不前， 女性特有的风险因素。其中一个因素，新发妊娠高血压疾病（HDP）， 与未来代谢综合征、慢性低度炎症和心脏病的2倍或更高风险相关 失败然而，大多数关于HDP后长期心力衰竭风险的研究大多集中在终末期， 疾病而不是无症状心功能不全的进展。此前的研究表明，即使 无症状的心肌功能障碍患者预后较差， 将来会出现症状性心力衰竭因此，及早识别高危人群的妇女 是至关重要的，并将允许实施干预策略，以延迟进展或防止 心力衰竭发作。在高收入环境中的研究很少，在SSA中没有一项研究评估了风险， 使用斑点追踪超声心动图（STE）研究HDP后亚临床心功能不全的相关性， 准确量化心肌力学，包括整体纵向应变（GLS），一个预后指标， 心血管疾病的不良后果。使用STE，我们的目标是了解和描述的存在和进展， 妊娠合并HDP后无症状心功能不全（目的1），并评估其贡献 通过比较有和没有新发高血压的妇女， 妊娠障碍（目标2和3）。研究结果将为开发新颖且可扩展的 筛查和监测策略，以管理HDP后的CVD风险，从而减少CVD和CVD- 撒哈拉以南非洲和全球的死亡率。