Correlation Between PAPP-A And HCY And Left Ventricular Diastolic Function In Patients With Severe Preeclampsia

Objective:Multiple echocardiographic parameters were used to evaluate left ventricular diastolic function in patients with severe preeclampsia(SPE)and its correlation with the expression of PAPP-A and HCY in the second and third trimester of pregnancy,and to explore the factors affecting the decline of diastolic function.Methods:Forty-seven patients diagnosed with SPE were randomly selected as SPE group and31 healthy pregnant women as the control group.The early diastolic peak flow rate E and late diastolic peak flow rate A were obtained by echocardiography in each group,and the E/A was calculated.Tissue Doppler(TDI)model sampling lines were placed at the mitral annulus of the spacer,lateral wall,anterior wall and lower wall,respectively.The motion spectrum was recorded to obtain the early diastolic motion peak e’,systolic motion peak s’ and isovolumic diastolic time(IVRT)at each position.The average e’,average s’ and average IVRT of the four walls were obtained,and the E/average e’ and average e’/average s’ were calculated.The maximum left atrial volume(LAVmax)was measured using full volume technique,and the maximum left atrial volume index(LAVI)was standardized by body surface area for comparison.In addition,PAPP-A and HCY were measured in the morning of the same day of fasting ultrasound examination.Partial correlation analysis was used to evaluate the correlation between PAPP-A and HCY and left ventricular diastolic function parameters.Multiple linear regression was used to analyze the factors affecting left ventricular diastolic function.Results:(1)Compared with the control group,peak A,E/mean e’,IVRT and LAVI in SPE group were significantly increased(all P<0.05),while E/A,mean e’,mean s’ and mean e’/s’ were significantly decreased(all P<0.05);Compared with the control group,PAPP-A and HCY were increased in SPE group,and the difference was statistically significant.(2)When the control variable was HCY,PAPPP-A was positively correlated with MAP,E/mean E/e’,IVRT and LAVI(r =0.329、0.237、0.270、0.260,all P<0.05).When the control variable was PAPP-A,the results showed that HCY was positively correlated with MAP and E/average e’(r =0.223、0.041,both P<0.05),and HCY was negatively correlated with average e’/s’(r =-0.308,P<0.01).(3)The results of multiple linear regression showed that MAP(β =0.067,P<0.0001),HCY(β =0.054,P=0.006<0.01)and BMI(β =0.151,P=0.045<0.05)were independent factors of E/e’。Conclusion:Tissue Doppler s’ can early identify the presence of left ventricular systolic impairment in patients with normal LVEF;PAPP-A and HCY were negatively correlated with left ventricular diastolic function,and increased PAPP-A and HCY levels in the middle and third trimester of pregnancy suggested impaired left ventricular diastolic function.The increase of MAP,BMI and HCY were independent factors affecting the reduction of left ventricular diastolic function.