Subclinical cardiac dysfunction after hypertensive disorders in pregnancy

7.摘要 心血管疾病(CVD)仍然是全球死亡的主要原因。约四分之三的心血管疾病 死亡发生在低收入和中等收入地区。尽管与心血管疾病相关的死亡人数逐渐下降 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。 由于女性特有的风险因素。其中一个因素，新发的妊娠期高血压疾病(HDP)是 与未来代谢综合征、慢性低度炎症和心脏的风险增加2倍或更多相关 失败了。然而，大多数关于HDP术后长期心力衰竭风险的研究大多集中在终末期。 而不是无症状性心功能障碍的进展。此前的研究表明，即使是 无症状的心肌功能障碍患者预后不良，风险增加。 将来会出现症状性心力衰竭。因此，及早识别妇女高危人群 是至关重要的，并将允许实施干预战略，以延缓进展或防止 心力衰竭的发作。在高收入环境中很少有研究，在SSA中没有研究评估风险和 斑点追踪超声心动图评价HDP术后亚临床心功能不全的相关性 准确量化心肌力学，包括全球纵向应变(GLS)，这是一种预测 心血管疾病的不良后果。使用STE，我们的目标是理解和描述 妊娠合并HDP后无症状性心功能不全(目标1)及其贡献 比较新发高血压患者和无新发高血压患者产后3年的炎症反应 妊娠障碍(目标2和3)。研究结果将为开发新的和可扩展的 筛查和监测策略，以管理HDP后的心血管风险，从而减少心血管疾病和心血管疾病 撒哈拉以南非洲和全球的死亡率。

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.