Cardiomyopathy and Pregnancy: Considerations for Women With Severely Reduced Left Ventricular Dysfunction

Shotan, Avraham; Roos‐Hesselink, Jolien W.; Bari, Lucia; Goland, Sorel; Yekel, Yael; Elkayam, Uri

doi:10.1016/j.cjca.2021.09.023

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…After delivery, uterine contraction and increased blood volume would furtherly aggravate the condition. However, despite the relatively high incidence of adverse events, all of the LHD-PH women survived, and most of them underwent a successful delivery, which was consistent with previous reports ( 6 , 12 ). The possible reason was that most of the underlying heart diseases were generally monitored and well-controlled before pregnancy, and most of the LHD-PH patients were in the mild to moderate PH group.…”

Section: Discussionsupporting

confidence: 90%

Pregnant outcomes of critically ill pregnant patients with pulmonary hypertension: A multicenter retrospective study

Zhang

Qie

Yin

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo identify the pregnancy outcomes and risk factors of critically ill pulmonary hypertension (PH) patients with intensive care unit (ICU) admission.MethodsThe multicenter, retrospective cohort study was performed on 60,306 parturients from January 2013 to December 2018 in China. Diagnosis of PH was based on the estimation of systolic pulmonary arterial pressure (sPAP) via echocardiography. Patients were stratified by sPAP into three groups, mild (30–50 mmHg), moderate (51–70 mmHg), and severe (>70 mmHg). The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of in-hospital death, heart failure, and sustained arrhythmias requiring treatment. The secondary outcome was fetal adverse clinical events (FACE), a composite of fetal/neonatal death, prematurity, small birth weight, and fetal distress.ResultsA total of 181 pregnant patients were enrolled, including 101 patients with mild PH, 31 with moderate PH, and 49 with severe PH. The maternal median age was 32 (27, 35) years and 37% were nulliparous. The MACE occurred in 59 (59/181, 32.6%) women, including in-hospital death in 13 (13/181, 7.2%), heart failure in 53 (53/181, 29.3%), and sustained arrhythmias in 7 (7/181, 3.9%). The incidence of FACE was as high as 66.3% (120/181). Compared with mild and moderate PH patients, patients with severe PH had a significantly higher mortality rate (22.4 vs. 1.51%, P < 0.001) and MACE incidence (51.0 vs. 25.8%, P = 0.001). Although the incidence of FACE in severe PH was slightly higher than that in mild to moderate PH, there was no significant difference (69.4 vs. 65.1%, P = 0.724). PH complicated with left heart disease (OR = 4.365, CI: 1.306–14.591), elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (OR = 1.051, CI:1.015–1.088), and sPAP level estimated by echocardiography (OR = 1.021; CI: 1.003–1.040) were independently associated with MACE in multivariable regression (P < 0.05). Increased risk of FACE was noted for PH patients combined with eclampsia/preeclampsia (OR = 6.713; CI: 1.806–24.959).ConclusionThe incidence of MACE and FACE remained high in critically ill pregnant patients with PH, particularly moderate and severe PH in China. Further studies are warranted to identify subsets of women with PH at lower pregnant risks and seek more effective therapy to improve pregnancy outcomes.

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Section: Discussionsupporting

confidence: 90%

Pregnant outcomes of critically ill pregnant patients with pulmonary hypertension: A multicenter retrospective study

Zhang

Qie

Yin

et al. 2022

Front. Cardiovasc. Med.

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“…Dilated cardiomyopathy (DCM), which may be inherited or acquired, is seen relatively rarely in pregnancy as a de novo condition; the majority of cases are known prior to conception [23][24][25][26][27]. This may be because it is difficult to distinguish clinically from PPCM during pregnancy.…”

Section: Dilated Cardiomyopathymentioning

confidence: 99%

Considerations for specific cardiomyopathies during pregnancy

Abrams

Magun

DeFilippis

2023

Current Opinion in Cardiology

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Purpose of reviewMaternal mortality in the United States continues to increase. Cardiovascular disease, and in particular, cardiomyopathy and heart failure, serves as one of the principal causes of pregnancy-related mortality. The goal of this review is to summarize current knowledge on various cardiomyopathies in pregnancy, with an emphasis on cardiomyopathies beyond the most common in pregnancy, peripartum cardiomyopathy.Recent findingsAlthough existing literature is somewhat limited, outcome studies of cardiomyopathy in pregnancy have demonstrated increased risk for adverse cardiovascular events and maternal morbidity and mortality. Herein, we review and synthesize recent studies focusing on preconception risk and counseling, pharmacologic management, and maternal outcomes in various cardiomyopathies during pregnancy including: dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, noncompaction cardiomyopathy, and chemotherapy-induced cardiomyopathy.SummaryIn an effort to optimize maternal outcomes, it is critical to recognize the risk associated with various cardiomyopathies in pregnancy and understand the tools for risk stratification and antepartum management. Further research on less common cardiomyopathies in pregnancy is warranted to provide more standardized recommendations.

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Severe Maternal Morbidity According to Mode of Delivery Among Pregnant Patients With Cardiomyopathies

Meng,

Federspiel,

Fuller

et al. 2023

JACC: Heart Failure

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Cardiomyopathy and Pregnancy: Considerations for Women With Severely Reduced Left Ventricular Dysfunction

Cited by 3 publications

References 33 publications

Pregnant outcomes of critically ill pregnant patients with pulmonary hypertension: A multicenter retrospective study

Pregnant outcomes of critically ill pregnant patients with pulmonary hypertension: A multicenter retrospective study

Considerations for specific cardiomyopathies during pregnancy

Severe Maternal Morbidity According to Mode of Delivery Among Pregnant Patients With Cardiomyopathies

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