Heart failure in pregnant women with cardiac disease: data from the ROPAC

Abstract

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

Almanac 2014: congenital heart disease

“…65 Data from the Registry On Pregnancy And Cardiac disease demonstrated that HF is a common complication in pregnant patients with cardiac disease (13%, of more than 1300 participants). 66 While the highest incidence of HF was found to be at the end of the second trimester or during childbirth, prevalence of HF was strongly associated with pre-eclampsia, premature birth and maternal and foetal mortality. However, patients with CHD had a relatively lower risk of developing HF compared with patients with valvular heart disease, ischaemic heart disease or cardiomyopathy.…”

Rationale and Design for the Peripartum Cardiomyopathy in Nigeria (PEACE) Registry

“…Several hemodynamic changes such as peripheral vasodilatation, increase in blood volume and cardiac output occur between the 1st and 2nd trimesters of pregnancy, and patients with known preexisting structural cardiac diseases typically present with clinical HF at this time [32,33]. In striking contrast, PPCM overwhelmingly presents during the postpartum period, and factors that modify the stresses of vaginal delivery such as caesarian section do not appear to modify the risk of developing the disease [33].…”

A contemporary review of peripartum cardiomyopathy

“…It has been postulated that these physiological adaptations may also be implicated in the cardiomyopathic phenotype. 11 However, these changes typically occur during the first and second trimesters and not in the peripartum period. Even when additional stresses implicated in delivery, (such as caesarean section), have been accounted for, propensity for developing PPCM does not appear to be significantly raised.…”