Objective

Cardiovascular disease (CVD) is the number one cause of death in women and defining its risk factors is necessary to reduce its prevalence. A history of preeclampsia is shown to be associated with hypertension and alterations in left ventricular (LV) diastolic function parameters. Because of overlapping mechanisms between preeclampsia and spontaneous preterm birth (SPTB), our most recent study investigated the association between SPTB and hypertension, and found an almost 2 times higher prevalence of hypertension after SPTB. No previous studies have focused on the association between SPTB and LV diastolic function. The aim of this study is to investigate LV diastolic function as potential early parameter of CVD in women with a history of SPTB.

Study design

We included cases with a history of SPTB between 22 and 37 weeks and controls who had a term birth. Women with hypertensive disorders or gestational diabetes in any of their pregnancies, were excluded. Both groups underwent cardiovascular risk assessment and transthoracic echocardiography 9 to 16 years after pregnancy. Echocardiographic measures were adjusted using a linear regression analysis accounting for hypertension and other risk factors known to be associated with CVD. A subgroup analysis was performed based on hypertension at follow-up.

Results

A total of 94 cases and 94 controls were included, on average 13 years after pregnancy. There were no significant differences in LV diastolic function parameters. Women with a history of SPTB and diagnosed hypertension at follow-up, showed significant higher late diastolic mitral flow velocity, lower e’septal velocity and higher E/e’ratio, compared to women with a history of SPTB without hypertension, although within normal ranges.

Conclusions

When a history of SPTB is accompanied by hypertension at follow-up, significant changes in LV diastolic function were seen. Therefore, hypertension is the central factor in preventive screening methods, and transthoracic echocardiography has no additional value at this follow-up duration.

中文翻译：

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有自发性早产史的女性 50 岁时的左心室舒张功能

客观的

心血管疾病（CVD）是女性死亡的第一大原因，确定其危险因素对于降低其患病率至关重要。研究显示先兆子痫病史与高血压和左心室 (LV) 舒张功能参数的改变有关。由于先兆子痫和自发性早产 (SPTB) 之间存在重叠机制，我们最近的研究调查了 SPTB 与高血压之间的关联，发现 SPTB 后高血压患病率几乎增加了 2 倍。之前没有研究关注 SPTB 与左室舒张功能之间的关联。本研究的目的是调查 LV 舒张功能作为有 SPTB 病史的女性 CVD 的潜在早期参数。

学习规划

我们纳入了 22 至 37 周内有 SPTB 病史的病例以及足月分娩的对照病例。在任何一次怀孕期间患有高血压或妊娠糖尿病的女性均被排除在外。两组患者均在妊娠后 9 至 16 年接受心血管风险评估和经胸超声心动图检查。使用线性回归分析调整超声心动图测量值，考虑高血压和其他已知与 CVD 相关的危险因素。根据随访时的高血压情况进行亚组分析。

结果

总共包括 94 例病例和 94 例对照，平均怀孕后 13 年。左室舒张功能参数没有显着差异。与有 SPTB 病史但无高血压的女性相比，有 SPTB 病史并在随访时诊断为高血压的女性显示出舒张末期二尖瓣血流速度显着较高、e'间隔速度较低和 E/e' 比较高，尽管在正常范围内范围。

结论

当 SPTB 病史伴随高血压随访时，左室舒张功能发生显着变化。因此，高血压是预防性筛查方法的核心因素，经胸超声心动图在此随访期间没有附加价值。