Pregnancy outcomes in women with dilated cardiomyopathy: Peripartum cardiovascular events predict post delivery prognosis

Yokouchi-Konishi, Tae; Kamiya, Chizuko; Shionoiri, Tadasu; Nakanishi, Atsushi; Iwanaga, Naoki; Izumi, Chisato; Yasuda, Satoshi; Yoshimatsu, Jun

doi:10.1016/j.jjcc.2020.07.007

Cited by 6 publications

(17 citation statements)

References 23 publications

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“…36 As the severity of HF is a strong predictor of the risk for cardiac complications in patients with cardiac disorders in general as well as in women during and after pregnancy in particular, quantifying the severity of HF using NP measurements may facilitate the detection of patients at high risk for cardiac complications and help appropriate referral. [37][38][39] During normal pregnancies in healthy women, NP concentrations remain in the normal range. 39,40 Pre-eclampsia and deterioration of cardiomyopathy/HF due to other causes will lead to an increase in NPs.…”

Section: Natriuretic Peptides For Screening and Risk Stratification To Help Ensure Appropriate Referralmentioning

confidence: 99%

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Sliwa

Meer

Petrie

et al. 2021

European J of Heart Fail

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This position paper focusses on the pathophysiology, diagnosis and management of women diagnosed with a cardiomyopathy, or at risk of heart failure (HF), who are planning to conceive or present with (de novo or previously unknown) HF during or after pregnancy. This includes the heterogeneous group of heart muscle diseases such as hypertrophic, dilated, arrhythmogenic right ventricular and non‐classified cardiomyopathies, left ventricular non‐compaction, peripartum cardiomyopathy, Takotsubo syndrome, adult congenital heart disease with HF, and patients with right HF. Also, patients with a history of chemo‐/radiotherapy for cancer or haematological malignancies need specific pre‐, during and post‐pregnancy assessment and counselling. We summarize the current knowledge about pathophysiological mechanisms, including gene mutations, clinical presentation, diagnosis, and medical and device management, as well as risk stratification. Women with a known diagnosis of a cardiomyopathy will often require continuation of drug therapy, which has the potential to exert negative effects on the foetus. This position paper assists in balancing benefits and detrimental effects.

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Section: Natriuretic Peptides For Screening and Risk Stratification To Help Ensure Appropriate Referralmentioning

confidence: 99%

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Sliwa

Meer

Petrie

et al. 2021

European J of Heart Fail

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“…By contrast, Yokouchi-Konishi et al [27] in a more recent analysis described a lower rate of maternal cardiac events, 23% ( n = 8) of thirty-five pregnancies in thirty women with preexisting DCM. Importantly, all patients were either NYHA Class I or II, which may explain the lower rate of adverse events [25].…”

Section: Considerations For Specific Cardiomyopathies During Pregnancymentioning

confidence: 86%

“…The reported frequencies of adverse maternal cardiac events have ranged in the literature from 23% to 60% depending on the patient population [23,24,27]. In one study of outcomes in pregnant women with DCM, the reported frequency of adverse maternal cardiac events was 39% (n ¼ 14) amongst 36 pregnancies in 32 women [23].…”

Section: Dilated Cardiomyopathymentioning

confidence: 99%

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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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“…According to the guideline of the European Society of Cardiology, 31 when LVEF becomes lower than 20% during pregnancy, the risk of maternal death is very high and a pregnancy should be terminated. In pregnancy cohort studies of dilated cardiomyopathy, including drug‐induced cardiomyopathy, the incidence of maternal cardiovascular complications was approximately 10%–40%, with risk factors including LVEF <45%, NYHA class III–IV, history of cardiovascular events, pre‐pregnancy medication use (angiotensin‐converting‐enzyme (ACE) inhibitor, angiotensin‐converting‐receptor blocker (ARB) and/or diuretics), and severe left ventricular dilated dysfunction 32–34 . Heart failure complications among pregnant women with dilated cardiomyopathy occur most often from the second half of pregnancy to 2 months after delivery (median 35 weeks' gestation) as circulatory plasma volume increases 35 …”

Section: Pregnancy Risk After Anticancer Therapymentioning

confidence: 99%

Cardiovascular disease among pregnant women after anticancer therapy

Aoki‐Kamiya

Shioyama

Nakagawa

et al. 2021

J of Obstet and Gynaecol

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Recent advances in cancer therapies have enabled many women diagnosed with malignancies during childhood and adolescence to survive longer and therefore to reach an age where they wish to conceive. When providing cancer treatment such as anticancer drugs and radiotherapy, attention is often paid to preserving future fertility, but little is known about maternal pregnancy risks, and in particular cardiovascular complications. Recent studies have shown that cardiovascular diseases such as cardiomyopathy, heart failure, and arrhythmias often occur during and soon after anticancer therapy. This has led to the emergence of the specialized field of “onco‐cardiology” or “cardio‐oncology,” in which oncologists and cardiologists collaborate, as well as the publication of multiple clinical practice guidelines. The interdisciplinary onco‐cardiology team plays an important role in further improving the prognosis of cancer survivors. The current recommendation for women after anticancer therapy who wish to conceive is to undergo cardiovascular screening, regardless of whether there is a history of cardiovascular complications or not, in order to provide preconception counseling. Pregnancies in cancer‐survivors, who experience cardiovascular complications, should be managed perinatally by a multidisciplinary team including obstetricians and cardiologists. Absence of cardiovascular disease on screening does not preclude the possibility that new cardiac dysfunction may occur during the perinatal period, especially in women with a history of high‐dose anthracycline drug administration and/or radiation therapy. In such high‐risk cases, follow‐up of cardiac function throughout the perinatal period is required.

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Pregnancy outcomes in women with dilated cardiomyopathy: Peripartum cardiovascular events predict post delivery prognosis

Cited by 6 publications

References 23 publications

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Considerations for specific cardiomyopathies during pregnancy

Cardiovascular disease among pregnant women after anticancer therapy

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