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Heart. 2010 Oct;96(20):1656-61. doi: 10.1136/hrt.2010.202838.

Cardiac outcomes after pregnancy in women with congenital heart disease.

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1
University of Toronto Pregnancy and Heart Disease Research Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

Women with congenital heart disease (CHD) are at risk for adverse cardiac events during pregnancy; however, the risk of events late after pregnancy (late cardiac events; LCE) has not been well studied. A study was undertaken to examine the frequency and determinants of LCE in a large cohort of women with CHD.

DESIGN:

Baseline characteristics and pregnancy were prospectively recorded. LCE (>6months after delivery) were determined by chart review. Survival analysis was used to determine the risk factors for LCE.

SETTING:

A tertiary care referral hospital.

PATIENTS:

The outcomes of 405 pregnancies were studied (318 women; median follow-up 2.6 years).

MAIN OUTCOME MEASURES:

LCE included cardiac death/arrest, pulmonary oedema, arrhythmia or stroke.

RESULTS:

LCE occurred after 12% (50/405) of pregnancies. The 5-year rate of LCE was higher in women with adverse cardiac events during pregnancy than in those without (27±9% vs 15±3%, HR 2.2, p=0.02). Women at highest risk for LCE were those with functional limitations/cyanosis (HR 3.9, 95% CI 1.2 to 13.0), subaortic ventricular dysfunction (HR 3.0, 95% CI 1.4 to 6.6), subpulmonary ventricular dysfunction and/or significant pulmonary regurgitation (HR 3.2, 95% CI 1.6 to 6.6), left heart obstruction (HR 2.6, 95% CI 1.2 to 5.2) and cardiac events before or during pregnancy (HR 2.6, 95% CI 1.3 to 4.9). In women with 0, 1 or >1 risk predictors the 5-year rate of LCE was 7±2%, 23±5% and 44±10%, respectively (p<0.001).

CONCLUSIONS:

In women with CHD, pre-pregnancy maternal characteristics can help to identify women at increased risk for LCE. Adverse cardiac events during pregnancy are important and are associated with an increased risk of LCE.

PMID:
20937754
DOI:
10.1136/hrt.2010.202838
[Indexed for MEDLINE]
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