PDF(Pubmed)
Abstract：
Peripartum cardiomyopathy (PPCM) is a form of new-onset heart failure that has a high rate of maternal morbidity and mortality. This was the first study to systematically investigate and compare clinical factors and echocardiographic findings between women with PPCM and co-incident hypertensive pregnancy disorders (HPD-PPCM) and PPCM-only women. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. We used four databases and a single search engine, namely PubMed/Medline, Scopus, Web of Science, and Cochrane. We used Cochrane Risk of Bias (RoB) 2.0 for quality assessment. Databases were searched for relevant articles published from 2013 to the end of April 2023. The meta-analysis used the DerSimonian-Laird random-effects model to analyze the pooled mean difference (MD) and its p-value. We included four studies with a total of 64,649 participants and found that systolic blood pressure was significantly more likely to be associated with the PPCM group than the HPD-PPCM group (SMD = -1.63) (95% CI; -4.92,0.28, p = 0.01), while the other clinical profiles were not significant. HPD-PPCM was less likely to be associated with LVEF reduction (SMD = -1.55, [CI: -2.89, -0.21], p = 0.02). HPD-PPCM was significantly associated with less LV dilation (SMD = 1.81; 95% (CI 0.07-3.01), p = 0.04). Moreover, HPD-PPCM was less likely to be associated with relative wall thickness reduction (SMD = 0.70; 95% CI (-1.08--0.33), p = 0.0003). In conclusion, PPCM and HPD-PPCM shared different clinical profiles and remodeling types, which may affect each disease\'s response to pharmacological treatment. Patients with HPD-PPCM exhibited less eccentric remodeling and seemed to have a higher chance of recovering their LV ejection fraction, which means they might not benefit as much from ACEi/ARB and beta-blockers. The findings of this study will guide the development of guidelines for women with PPCM and HPD-PPCM from early detection to further management.
摘要：
围产期心肌病（PPCM）是一种新发心力衰竭，具有很高的孕产妇发病率和死亡率。这是第一项系统调查和比较PPCM和并发高血压妊娠疾病（HPD-PPCM）女性与仅PPCM女性之间的临床因素和超声心动图检查结果的研究。我们遵循系统评价和荟萃分析(PRISMA)框架的首选报告项目。我们使用了四个数据库和一个搜索引擎，即PubMed/Medline，Scopus,WebofScience,还有Cochrane.我们使用Cochrane偏差风险(RoB)2.0进行质量评估。在数据库中搜索了2013年至2023年4月底发表的相关文章。荟萃分析使用DerSimonian-Laird随机效应模型来分析合并均值差异（MD）及其p值。我们纳入了四项研究，共64,649名参与者，发现收缩压与PPCM组的相关性明显高于HPD-PPCM组（SMD=-1.63）（95％CI;-4.92,0.28，p=0.01），而其他临床资料则不显著。HPD-PPCM与LVEF降低的可能性较小（SMD=-1.55，[CI：-2.89，-0.21]，p=0.02)。HPD-PPCM与左心室扩张减少显著相关(SMD=1.81;95%(CI0.07-3.01),p=0.04)。此外，HPD-PPCM不太可能与相对壁厚减小相关(SMD=0.70;95%CI(-1.08--0.33),p=0.0003)。总之,PPCM和HPD-PPCM具有不同的临床特征和重塑类型，这可能会影响每种疾病对药物治疗的反应。HPD-PPCM患者表现出更少的偏心重塑，似乎有更高的机会恢复他们的左心室射血分数。这意味着他们可能不会从ACEi/ARB和β受体阻滞剂中获益。这项研究的结果将指导从早期发现到进一步管理的PPCM和HPD-PPCM女性指南的制定。
