RT Journal Article
SR Electronic
T1 Heart failure in pregnant women with cardiac disease: data from the ROPAC
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 231
OP 238
DO 10.1136/heartjnl-2013-304888
VO 100
IS 3
A1 Titia P E Ruys
A1 Jolien W Roos-Hesselink
A1 Roger Hall
A1 Maria T Subirana-Domènech
A1 Jennifer Grando-Ting
A1 Mette Estensen
A1 Roberto Crepaz
A1 Vlasta Fesslova
A1 Michelle Gurvitz
A1 Julie De Backer
A1 Mark R Johnson
A1 Petronella G Pieper
YR 2014
UL http://heart.bmj.com/content/100/3/231.abstract
AB Objective Heart failure (HF) is one of the most important complications in pregnant women with heart disease, causing maternal and fetal mortality and morbidity. Methods This is an international observational registry of patients with structural heart disease during pregnancy. Sixty hospitals in 28 countries enrolled 1321 women between 2007 and 2011. Pregnant women with valvular heart disease, congenital heart disease, ischaemic heart disease, or cardiomyopathy could be included. Main outcome measures were onset and predictors of HF and maternal and fetal death. Results In total, 173 (13.1%) of the 1321 patients developed HF, making HF the most common major cardiovascular complication during pregnancy. Baseline parameters associated with HF were New York Heart Association class ≥3, signs of HF, WHO category ≥3, cardiomyopathy or pulmonary hypertension. HF occurred at a median time of 31 weeks gestation (IQR 23–40) with the highest incidence at the end of the second trimester (34%) or peripartum (31%). Maternal mortality was higher in patients with HF (4.8% in patients with HF and 0.5% in those without HF p<0.001). Pre-eclampsia was strongly related to HF (OR 7.1, 95% CI 3.9 to 13.2, p<0.001). Fetal death and the incidence of preterm birth were higher in women with HF compared to women without HF (4.6% vs 1.2%, p=0.001; and 30% vs 13%, p=0.001). Conclusions HF was the most common complication during pregnancy, and occurred typically at the end of the second trimester, or after birth. It was most common in women with cardiomyopathy or pulmonary hypertension and was strongly associated with pre-eclampsia and an adverse maternal and perinatal outcome.