Cardiac Structure, Function and Mechanics in Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis.

IF 6.9 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

Hypertension Pub Date : 2025-05-14 DOI:10.1161/hypertensionaha.124.24472

Jamie J Edwards,Veronica Giorgione,Megan Griffiths,Claire Compton,Evelyn Greenhough,Elliot Smith,Eliane Cunliffe,Navazh Jalaludeen,Thomas Yates,Claire Meek,Joseph Cheriyan,Anna Marciniak,Baskaran Thilaganathan,Rajan Sharma,Jamie M O'Driscoll

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引用次数: 0

Abstract

BACKGROUND Hypertensive disorders of pregnancy (HDP) are among the most common pregnancy complications and leading causes of maternal morbidity and mortality worldwide. This study aimed to perform the largest meta-analysis to date comparing conventional and advanced echocardiographic features in HDP against healthy pregnancy. METHODS PubMed (MEDLINE) and EMBASE were systematically searched for research articles published up to March 2024. Included studies reported at least 1 relevant echocardiographic parameter in pregnancies complicated by HDP and normotensive healthy pregnancies separately. A total of 53 studies met the inclusion criteria, comprising 7168 participants (3381 HDP and 3787 controls). RESULTS Myocardial mechanics, as measured by global longitudinal strain (weighted mean difference (WMD), -2.81% [95% CI, -3.70 to -1.91]; P<0.001) and left atrial reservoir strain (WMD, -9.36% [95% CI, -12.73 to -5.99]; P<0.001), were significantly impaired in HDP compared with healthy pregnancy. Furthermore, there were prominent cardiac structural differences, with significantly greater left ventricular mass index (WMD, 12.20 [95% CI, 9.77-14.64]; P<0.001), relative wall thickness (WMD, 0.055 [95% CI, 0.04-0.07]; P<0.001), left atrial size (WMD, 2.34 cm [95% CI, 1.62-3.06]; P<0.001), and left atrial volume index (WMD, 2.38 mL/m2 [95% CI, 1.44-3.32]; P<0.001) in HDP compared with healthy pregnancy. Finally, the ratio between early mitral inflow velocity and early mitral annular velocity average was significantly greater in HDP (WMD, 1.90 [95% CI, 1.42-2.38; P<0.001), indicative of an elevated left ventricular filling pressure. CONCLUSIONS This meta-analysis highlights clinically relevant differences in echocardiographic measures between HDP and healthy pregnancy. These results may enhance the utilization of echocardiography for the risk stratification and management of women with HDP. Advanced myocardial mechanics, including global longitudinal strain and left atrial reservoir strain, likely play a key role in detecting subclinical myocardial dysfunction and guidance for early intervention.

查看原文本刊更多论文

妊娠期高血压疾病的心脏结构、功能和机制：系统综述和荟萃分析。

妊娠高血压疾病（HDP）是最常见的妊娠并发症之一，也是全世界孕产妇发病和死亡的主要原因。本研究旨在进行迄今为止最大的荟萃分析，比较HDP对健康妊娠的传统和先进超声心动图特征。方法系统检索截止到2024年3月发表的研究论文。纳入的研究分别报道了合并HDP的妊娠和血压正常的健康妊娠至少1个相关超声心动图参数。共有53项研究符合纳入标准，包括7168名参与者（3381名HDP和3787名对照）。结果心肌力学，以整体纵向应变（加权平均差（WMD））测量，-2.81% [95% CI, -3.70至-1.91]；P<0.001)和左心房贮液应变(WMD, -9.36% [95% CI, -12.73 ~ -5.99]；P<0.001)，与健康妊娠相比，HDP明显受损。此外，心脏结构差异显著，左心室质量指数显著高于对照组(WMD, 12.20 [95% CI, 9.77-14.64]；P<0.001)，相对壁厚(WMD, 0.055 [95% CI, 0.04-0.07]；P<0.001)，左心房大小(WMD, 2.34 cm [95% CI, 1.62-3.06]；P<0.001)，左房容积指数(WMD, 2.38 mL/m2 [95% CI, 1.44-3.32]；P<0.001)。最后，HDP患者早期二尖瓣流入速度与早期二尖瓣环状平均速度之比显著大于(WMD, 1.90 [95% CI, 1.42-2.38；P<0.001)，表明左心室充盈压升高。结论本荟萃分析强调了HDP与健康妊娠超声心动图指标的临床相关差异。这些结果可能会提高超声心动图在HDP妇女风险分层和管理中的应用。先进的心肌力学，包括整体纵应变和左心房储层应变，可能在检测亚临床心肌功能障碍和指导早期干预方面发挥关键作用。

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来源期刊

Hypertension 医学-外周血管病

CiteScore

15.90

自引率

4.80%

发文量

1006

审稿时长

1 months

期刊介绍： Hypertension presents top-tier articles on high blood pressure in each monthly release. These articles delve into basic science, clinical treatment, and prevention of hypertension and associated cardiovascular, metabolic, and renal conditions. Renowned for their lasting significance, these papers contribute to advancing our understanding and management of hypertension-related issues.