Association of Hypertensive Disorders of Pregnancy With Coronary Microvascular Dysfunction 8 to 10 Years After Delivery.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2024-05-01 Epub Date: 2024-05-21 DOI:10.1161/CIRCIMAGING.124.016561

Malamo E Countouris, Janet M Catov, Jianhui Zhu, Nikki de Jong, Judith Brands, Xucai Chen, W Tony Parks, Kathryn L Berlacher, Robin E Gandley, Adam C Straub, Flordeliza S Villanueva

{"title":"Association of Hypertensive Disorders of Pregnancy With Coronary Microvascular Dysfunction 8 to 10 Years After Delivery.","authors":"Malamo E Countouris, Janet M Catov, Jianhui Zhu, Nikki de Jong, Judith Brands, Xucai Chen, W Tony Parks, Kathryn L Berlacher, Robin E Gandley, Adam C Straub, Flordeliza S Villanueva","doi":"10.1161/CIRCIMAGING.124.016561","DOIUrl":null,"url":null,"abstract":"Background: Hypertensive disorders of pregnancy (HDP) are associated with subsequent adverse cardiac remodeling and cardiovascular disease. The role of myocardial microvascular disease among individuals with HDP and left ventricular (LV) remodeling as a potential link to cardiovascular disease is unknown. We aimed to determine whether individuals with HDP history have coronary microvascular dysfunction measured by coronary flow reserve 8 to 10 years after delivery and whether microvascular dysfunction correlates with LV remodeling.Methods: Individuals with pregnancies delivered from 2008 to 2010 underwent burst-replenishment myocardial contrast echocardiography (2017-2020) to quantify myocardial perfusion at rest and during dobutamine stress. Video intensity versus time data were used to derive β, the rate of rise of video intensity, a correlate for myocardial blood flow. Coronary flow reserve was calculated as the ratio of β at peak stress to β at rest, averaged across LV myocardial regions of interest.Results: We studied 91 individuals (aged 38±6 and 9.1±0.9 years postdelivery) and 19 with a history of HDP. Individuals with coronary microvascular dysfunction (coronary flow reserve <2.0; n=13) had a higher proportion of HDP (46.2% versus 16.7%; P=0.026) and higher prepregnancy body mass index, baseline heart rate, and hemoglobin A1c compared with those without microvascular dysfunction. The association of coronary flow reserve and HDP was attenuated after adjusting for cardiometabolic factors (P=0.133). In exploratory subgroup analyses, individuals with both LV remodeling (relative wall thickness >0.42) and HDP (n=12) had the highest proportion of microvascular dysfunction (41.7% versus +HDP-LV remodeling [n=7] 14.3%; -HDP+LV remodeling [n=26] 7.7%; P=0.0498).Conclusions: In this small study, HDP history is associated with coronary microvascular dysfunction 1 decade after delivery, findings that may, in part, be driven by metabolic factors including obesity and diabetes. Microvascular dysfunction may contribute to cardiovascular disease among individuals with a history of HDP.","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":6.5000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11115371/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCIMAGING.124.016561","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/21 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Hypertensive disorders of pregnancy (HDP) are associated with subsequent adverse cardiac remodeling and cardiovascular disease. The role of myocardial microvascular disease among individuals with HDP and left ventricular (LV) remodeling as a potential link to cardiovascular disease is unknown. We aimed to determine whether individuals with HDP history have coronary microvascular dysfunction measured by coronary flow reserve 8 to 10 years after delivery and whether microvascular dysfunction correlates with LV remodeling.

Methods: Individuals with pregnancies delivered from 2008 to 2010 underwent burst-replenishment myocardial contrast echocardiography (2017-2020) to quantify myocardial perfusion at rest and during dobutamine stress. Video intensity versus time data were used to derive β, the rate of rise of video intensity, a correlate for myocardial blood flow. Coronary flow reserve was calculated as the ratio of β at peak stress to β at rest, averaged across LV myocardial regions of interest.

Results: We studied 91 individuals (aged 38±6 and 9.1±0.9 years postdelivery) and 19 with a history of HDP. Individuals with coronary microvascular dysfunction (coronary flow reserve <2.0; n=13) had a higher proportion of HDP (46.2% versus 16.7%; P=0.026) and higher prepregnancy body mass index, baseline heart rate, and hemoglobin A1c compared with those without microvascular dysfunction. The association of coronary flow reserve and HDP was attenuated after adjusting for cardiometabolic factors (P=0.133). In exploratory subgroup analyses, individuals with both LV remodeling (relative wall thickness >0.42) and HDP (n=12) had the highest proportion of microvascular dysfunction (41.7% versus +HDP-LV remodeling [n=7] 14.3%; -HDP+LV remodeling [n=26] 7.7%; P=0.0498).

Conclusions: In this small study, HDP history is associated with coronary microvascular dysfunction 1 decade after delivery, findings that may, in part, be driven by metabolic factors including obesity and diabetes. Microvascular dysfunction may contribute to cardiovascular disease among individuals with a history of HDP.

查看原文本刊更多论文

妊娠期高血压疾病与产后 8-10 年冠状动脉微血管功能障碍的关系

背景：妊娠期高血压疾病（HDP）与随后的不良心脏重塑和心血管疾病有关。HDP患者的心肌微血管疾病和左心室（LV）重塑与心血管疾病的潜在联系尚不清楚。我们的目的是确定有HDP病史的人在分娩后8到10年是否存在冠状动脉微血管功能障碍（通过冠状动脉血流储备测量），以及微血管功能障碍是否与左心室重塑相关：2008年至2010年期间分娩的孕妇接受了猝发补体心肌对比超声心动图检查（2017-2020年），以量化静息时和多巴酚丁胺应激时的心肌灌注。利用视频强度与时间的关系数据得出视频强度的上升率β，这是心肌血流的相关指标。冠状动脉血流储备是根据峰值应激时的β与静息时的β之比计算出来的，在左心室相关心肌区域取平均值：我们研究了 91 例患者（年龄为 38±6 岁和产后 9.1±0.9 年）和 19 例有 HDP 病史的患者。与无微血管功能障碍者相比，冠状动脉微血管功能障碍者（冠状动脉血流储备P=0.026）和孕前体重指数、基线心率和血红蛋白A1c较高。在调整了心脏代谢因素后，冠状动脉血流储备与 HDP 的关系有所减弱（P=0.133）。在探索性亚组分析中，同时患有左心室重塑（相对室壁厚度>0.42）和HDP（12人）的人微血管功能障碍的比例最高（41.7%，而+HDP-左心室重塑[7人]为14.3%；-HDP+左心室重塑[26人]为7.7%；P=0.0498）：在这项小型研究中，HDP 史与分娩后十年的冠状动脉微血管功能障碍有关，其部分原因可能是肥胖和糖尿病等代谢因素。微血管功能障碍可能会导致有 HDP 史的人患心血管疾病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.