Pregnancy Outcomes in Women With Dilated Cardiomyopathy

Grewal, Jasmine; Siu, Samuel C.; Ross, Heather J.; Mason, Jennifer; Bálint, O; Sermer, Mathew; Colman, Jack M.; Silversides, Candice K.

doi:10.1016/j.jacc.2009.08.036

Cited by 158 publications

(101 citation statements)

References 21 publications

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“…(Prebitero et al, 2009) In a study on pregnancy in patients with dilated cardiomyopathy, an OR of 43 was found for moderate or severe left ventricular dysfunction and 39% of the pregnancies where complicated. (Grewal et al, 2009) Risk factors for adverse events were moderate (EF 30%-44%) or severe (EF<30%) ventricular dysfunction and NYHA class III or IV at baseline or prior cardiac event. Compared with non-pregnant patients with dilated cardiomyopathy, pregnant patients needed more medication and adverse cardiac events were more common.…”

Section: A 41 Year Old Patient Presented To the Out Patient Departmenmentioning

confidence: 98%

Coronary Artery Disease and Pregnancy

Ruys¹,

Johnson²,

Roos‐Hesselink³

2012

Coronary Artery Disease - Current Concepts in Epidemiology, Pathophysiology, Diagnostics and Treatment

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Section: A 41 Year Old Patient Presented To the Out Patient Departmenmentioning

confidence: 98%

Coronary Artery Disease and Pregnancy

Ruys¹,

Johnson²,

Roos‐Hesselink³

2012

Coronary Artery Disease - Current Concepts in Epidemiology, Pathophysiology, Diagnostics and Treatment

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“…It has generally a family history and can rapidly deteriorate during pregnancy due to hemodynamic load. 15,69 Women with dilated cardiomyopathy should be advised about maternal risk, especially when LVEF is <40% and should be suggested to terminate if LVEF is under 20%. In case of mother's refuse, it is necessary for her to be followed up by a tertiary center with a multidisciplinary team.…”

Section: Dilated Cardiomyopathymentioning

confidence: 99%

Pregnancy and heart disease: what Internists should know

Gerloni

Panuccio²

2017

Ital J Med

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Cardiac disease can rarely complicate pregnancy (e.g., only 1 to 4% of pregnancies in the United States), but it still remains a major cause of non-obstetric maternal morbidity and mortality. 1 During pregnancy, a woman can suffer from heart failure because of a pre-existing heart disease or a new onset cardiopathy pregnancy correlated. Approximately 2% of pregnancies involve cardiac disease, and in the current era, most maternal disease is due to congenital heart disease (CHD).2 Currently cardiac surgery improvement of the last 50 years has permitted an increased number of survivors. Instead, in the past, rheumatic heart disease was the leading cause of heart failure in pregnancy.3,4 Further, with increasing maternal age, other etiologies of heart disease should not be ignored and, particularly, ischemic and hypertensive heart disease should be considered in an over forty pregnant women. 5 Physiology of normal pregnancyImportant hemodynamic changes appear during pregnancy and are responsible for heart failure in pregnant women with pre-existing heart disease. These changes begin early in pregnancy, generally during the first eight weeks, reach their peak during the late second trimester, and then remain relatively constant until delivery. 6 The plasma volume and red cell mass are the first major cardiocirculatory modification, actually they expand in the 8 th week and peak around 30 th week, with a net plasma volume gain of 1000-1600 mL, corresponding to 30-50% above baseline.7 A greater increase in intravascular volume compared to red cell mass results in the dilutional anemia of pregnancy. This aspect generally results at 30-34 weeks when plasma volume peaks in relation to red cell mass and is associated with sodium and water retention. Actually 1000 mEq of sodium and 6 liters of water are retained and distributed among amniotic fluid, fetus and intra and extracellular spaces.8 Further cardiac output increases to satisfy increase fetal and maternal metabolic needs. It can be estimated 30-50% above baseline levels during the entire pregnancy, but half of this change occurs by 8 th week. This relevant change is a consequence of blood volume augmentation, afterload reduction and maternal heart rate rise.9 Systemic Pregnancy and heart disease: what Internists should know ABSTRACTPregnant women with heart disease are increasing due to medical and surgical progress and, nowadays, congenital heart disease is the most frequent heart disease affecting these women. Pregnancy represents a considerable effort for an altered heart with negative consequences for life quality, disease progression and mortality. Risk differs a lot among patients and depends not only on the type of heart disease. Clinician should stratify risk and offer patients a correct pre-counselling and accurate follow-up. At the same time Clinician should be able to diagnose rapidly heart failure as some cardiopathies, such as peripartum cardiomyopathy, are related to pregnancy and produce symptoms that can be confused with normal pregnancy progression...

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“…31 An analysis of adverse outcomes during pregnancy in women with DCM revealed that there were no adverse events in women with none of these 3 clinical parameters (moderate or severe LV dysfunction, NYHA functional class III or IV, and/or a previous cardiac event). 32 In clinical practice, asymptomatic women with mild DCM mostly tolerated pregnancy well. Therefore, it is reasonable to surmise PPCM-specific factors, such as angiogenic imbalance, also affect many women with a positive genetic background of DCM and aggravate the condition.…”

Section: Ppcm and Hypertensive Disordersmentioning

confidence: 99%