Diagnosis, treatment and evaluation of preeclampsia complicated with heart failure

doi:10.3877/cma.j.issn.2095-3259.2022.04.008

Abstract

Abstract:

Objective

To investigate the characteristics, diagnosis, treatment and outcome of preeclampsia complicated with heart failure.

Methods

A retrospective study was conducted to collect 2960 cases of preeclampsia diagnosed in the Third Affiliated Hospital of Guangzhou Medical University from January 2009 to December 2019, including 142 cases of preeclampsia complicated with heart failure. The difference between preeclampsia group and preeclampsia complicated with heart failure group, the relationship between BNP level, LVEF, left ventricular diastolic function in different gestational weeks and heart failure degree, and the difference in pregnancy outcome were analyzed.

Results

(1) The gestational weeks of admission and delivery in preeclampsia complicated with heart failure group were earlier than those in preeclampsia group (P<0.05), the ICU referral rate (49.30% vs 6.03%), cesarean section termination rate (90.14% vs 70.97%) and ICU hospitalization days were increased. (2) There was a difference in the incidence of grade Ⅳ heart failure between patients with early-onset preeclampsia and those with late-onset preeclampsia(P<0.05), and there was no significant difference in the Ⅰ~Ⅲ degree of heart failure, type of heart failure, left ventricular diastolic dysfunction, LVEF and BNP levels in other grades (P>0.05). (3) The severity of heart failure was positively correlated with BNP level, ICU length of stay (P<0.05). (4) There was no significant difference between different gestational weeks and LVEF, BNP level, ICU hospitalization and total length of stay (P<0.05).

Conclusions

Heart failure is a serious complication of preeclampsia, which can be reflected in decreased LVEF and increased BNP level. The severity of heart failure is closely related to BNP level, mode of delivery, gestational week of delivery, ICU hospitalization and total length of hospital stay.

Key words: Preeclampsia, Heart failure, Natriuretic peptide, brain, Ultrasonography

Yanmei Zhou, Wen Sun, Lin Lin, Juanjuan Chen, Peili Du, Huili Zhang, Jingsi Chen, Lili Du, Dunjin Chen. Diagnosis, treatment and evaluation of preeclampsia complicated with heart failure[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2022, 11(04): 228-233.

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References 17

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类型		诊断标准
射血分数下降的心衰(HFrEF)	症状和(或)体征	LVEF≤40%	－
射血分数中间值心衰(HFmrEF)	症状和(或)体征	LVEF 41%~49%	利钠肽升高，并符合以下至少1条：(1)左心室肥厚和(或)左心房扩大；(2)心脏舒张功能异常
射血分数保留的心衰(HFpEF)	症状和(或)体征	LVEF≥50%	利钠肽升高，并符合以下至少1条：(1)左心室肥厚和(或)左心房扩大；(2)心脏舒张功能异常

类型		诊断标准
射血分数下降的心衰(HFrEF)	症状和(或)体征	LVEF≤40%	－
射血分数中间值心衰(HFmrEF)	症状和(或)体征	LVEF 41%~49%	利钠肽升高，并符合以下至少1条：(1)左心室肥厚和(或)左心房扩大；(2)心脏舒张功能异常
射血分数保留的心衰(HFpEF)	症状和(或)体征	LVEF≥50%	利钠肽升高，并符合以下至少1条：(1)左心室肥厚和(或)左心房扩大；(2)心脏舒张功能异常

分组	例数	年龄(岁，±s)	孕次(次，±s)	产次(次，±s)	产检次数(次，±s)	入院孕周(周，±s)
子痫前期	2818	31.74±5.48	2.46±1.46	0.57±0.72	6.51±3.74	34.11±4.63
子痫前期并发心力衰竭	142	31.13±5.82	2.44±1.41	0.68±0.80	3.62±3.69	32.31±4.25
统计值		t＝1.293	t＝0.098	t＝－1.628	t＝6.386	t＝4.530
P值		0.323	0.870	0.061	0.430	0.033
分组	例数	分娩孕周(周，±s)	剖宫产[例(%)]	转ICU[例(%)]	ICU住院时间(d，±s)	总住院时间(d，±s)
子痫前期	2818	34.54±4.57	2000(70.97%)	170(6.03%)	0.28±1.28	8.46±5.25
子痫前期并发心力衰竭	142	32.60±4.12	128(90.14%)	70(49.30%)	2.50±5.30	11.55±14.50
统计值		t＝4.969	χ²＝24.213	χ²＝342.843	χ²＝－4.989	χ²＝－2.531
P值		0.029	0.000	0.000	0.000	0.012

分组	例数	年龄(岁，±s)	孕次(次，±s)	产次(次，±s)	产检次数(次，±s)	入院孕周(周，±s)
子痫前期	2818	31.74±5.48	2.46±1.46	0.57±0.72	6.51±3.74	34.11±4.63
子痫前期并发心力衰竭	142	31.13±5.82	2.44±1.41	0.68±0.80	3.62±3.69	32.31±4.25
统计值		t＝1.293	t＝0.098	t＝－1.628	t＝6.386	t＝4.530
P值		0.323	0.870	0.061	0.430	0.033
分组	例数	分娩孕周(周，±s)	剖宫产[例(%)]	转ICU[例(%)]	ICU住院时间(d，±s)	总住院时间(d，±s)
子痫前期	2818	34.54±4.57	2000(70.97%)	170(6.03%)	0.28±1.28	8.46±5.25
子痫前期并发心力衰竭	142	32.60±4.12	128(90.14%)	70(49.30%)	2.50±5.30	11.55±14.50
统计值		t＝4.969	χ²＝24.213	χ²＝342.843	χ²＝－4.989	χ²＝－2.531
P值		0.029	0.000	0.000	0.000	0.012

分组	例数	心功能Ⅰ级[例(%)]	心功能Ⅱ级[例(%)]	心功能Ⅲ级[例(%)]	心功能Ⅳ级[例(%)]	HFrEF[例(%)]	HFmrEF[例(%)]	HFpEF[例(%)]	BNP(pg/ml，±s)
早发型	102	1(0.98%)	11(10.78%)	20(19.61%)	70(68.63%)	4(3.92%)	13(12.75%)	85(83.33%)	2793.36±3261.85
晚发型	40	1(0.25%)	8(20.00%)	11(27.50%)	20(50.00%)	2(5.00%)	7(17.50%)	31(77.50%)	2021.92±2852.03
统计值		χ²＝0.478	χ²＝2.105	χ²＝1.049	χ²＝4.295	χ²＝0.083	χ²＝0.537	χ²＝0.654	t＝1.264
P值		0.485	0.121	0.210	0.031	0.543	0.314	0.280	0.209

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