二维斑点追踪评估子痫产前、产后心血管功能变化

    Two-dimensional speckle tracking for evaluating cardiovascular functional changes in preeclampsia patients during pregnancy and postpartum

    • 摘要:
      目的 应用超声二维斑点追踪技术(2D-STE)评估子痫前期(PE)患者产前及产后心血管应变功能的变化规律及其相关性。
      方法 回顾性分析2020年11月~2022年12月就诊的30例PE孕妇(PE组)和33例正常妊娠孕妇(对照组)的临床资料。采用Esaote Mylab twice超声诊断仪测量两组产前及产后的左心房、左心室及颈总动脉应变参数,并进行相关性分析。
      结果 与正常妊娠组比较,子痫前期组孕妇收缩压(P<0.05)、舒张压(P<0.01)以及平均动脉压(P<0.01)均明显升高;产前与正常妊娠组比较,产前子痫前期患者左房容积指数显著增加(P<0.05);颈总动脉血管径向应变率(RAD-SR)显著降低(P<0.01)。产后与正常妊娠组比较,产后子痫前期患者左房应变泵功能显著增加(P<0.01),左房应变通道功能显著降低(P<0.01);而子痫前期患者的左房容积指数和血管径向应变率较正常妊娠组无明显统计学差别。产前正常妊娠组与产后正常妊娠组比较,左房应变泵功能显著降低(P<0.01),左室整体长轴应变及应变率显著增加(均P<0.01);产前子痫前期组与产后子痫前期组比较,左室整体长轴应变、应变率及颈总动脉径向应变率显著增加(均P<0.01);相关性分析显示产前PE组左房应变储备功能、通道功能与左室整体长轴应变(GLS)呈负相关(r=−0.417,−0.398),与颈总动脉外膜环向应变(EP-CS)呈正相关(r=0.420,0.411);产后左房应变储备功能、泵功能与左室整体长轴应变率(GLSR)呈正相关(r=0.637,0.584),GLS与颈总动脉内膜环向应变(EN-CS)及应变率(EN-CSR)呈负相关(r=−0.638,−0.641),GLSR与颈总动脉血管内膜环向应变率(EN-CSR)及血管外膜环向应变率(EP-CSR)呈正相关(r=0.628,0.671),均P<0.05。
      结论 超声二维斑点追踪技术能够敏感反应子痫前期患者产前、产后心血管结构和功能变化及其相关性,对于子痫前期患者产后心血管结构和功能转归的评价具有重要临床应用价值。

       

      Abstract:
      AIM  To assess alterations in cardiov ascular strain function in patients with preeclampsia (PE) before and after delivery via two-dimensional speckle-tracking echocardiography (2D-STE), and to evaluate their correlations.
      METHODS  A retrospective analysis was conducted on the clinical data of 30 pregnant women with PE (PE group) and 33 normal pregnant women (control group) who had attended our hospital between November 2020 and December 2022. All participants underwent echocardiographic examination using an Esaote Mylab Twice ultrasound system. Left atrial, left ventricular, and common carotid artery strain parameters were measured and compared between groups pre- and post-delivery. Correlation analyses were performed among key parameters.
      RESULTS Compared with the normal pregnancy group, the pre eclampsia group had significantly increased systolic blood pressure (P<0.05), diastolic blood pressure (P<0.01), and mean arterial pressure (P<0.01); Compared with the normal pregnancy group, the left atrial volume index of preeclampsia patients before delivery significantly increased (P<0.05); The radial strain rate (RAD-SR) of the common carotid artery was significantly reduced (P<0.01). Compared with the normal pregnancy group, postpartum preeclampsia patients showed a significant increase in left atrial strain pump function (P<0.01) and a significant decrease in left atrial strain channel function (P<0.01); However, there was no significant statistical difference in left atrial volume index and vascular radial strain rate between patients with preeclampsia and the normal pregnancy group. Compared with the postpartum normal pregnancy group, the left atrial strain pump function was significantly reduced in the prenatal normal pregnancy group (P<0.01), and the overall long axis strain and strain rate of the left ventricle were significantly increased (both P<0.01); Compared with the postpartum preeclampsia group, the overall long axis strain, strain rate, and radial strain rate of the left ventricle in the pre eclampsia group were significantly increased (all P<0.01); Correlation analysis showed that the strain reserve function and channel function of the left atrium in the prenatal PE group were negatively correlated with the overall long axis strain (GLS) of the left ventricle (r=−0.417, −0.398), and positively correlated with the circumferential strain of the common carotid artery outer membrane (EP-CS) (r=0.420, 0.411); Postpartum left atrial strain reserve function, pump function, and overall left ventricular long axis strain rate (GLSR) are positively correlated (r=0.637, 0.584), while GLS is negatively correlated with carotid artery intima circumferential strain (EN-CS) and strain rate (EN-CSR) (r=−0.638, −0.641). GLSR is positively correlated with carotid artery intima circumferential strain rate (EN-CSR) and epicardial circumferential strain rate (EP-CSR) (r=0.628, 0.671), both P<0.05.
      CONCLUSION  2D-STE is a sensitive tool for detecting changes in cardiovascular structure and function in patients with PE before and after delivery. This study has important clinical value for the evaluation of postpartum cardiovascular structure and function in patients with PE.

       

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