Maternal and neonatal outcomes in women with history of coronary artery disease

Cauldwell, Matthew; Steer, Philip; Klemperer, Kate von; Kaler, Mandeep; Grixti, Sarah Sultana; Hale, Joanna; O’heney, Josie; Warriner, David; Curtis, Stephanie; Mohan, Aarthi R.; Dockree, Samuel; Mackillop, Lucy; Head, Catherine; Sterrenberg, Monique; Wallace, Suzanne; Freeman, Leisa J; Patridge, Gemma; Baalman, Jelle; McAuliffe, Fionnuala M.; Simpson, Margaret; Walker, Niki L.; Girling, Joanna; Siddiqui, Farah; Bolger, Aidan P.; Bredaki, Foteini E.; Walker, Fiona; Vause, Sarah; Johnson, Mark R.; Roberts, Anna

doi:10.1136/heartjnl-2019-315325

Cited by 14 publications

(8 citation statements)

References 29 publications

(29 reference statements)

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“…The second largest case series to date included 92 pregnancies to 79 women in Europe with an adverse cardiac event rate of 6.6% and with limitations similar to those of the study mentioned above. 18 To summarize, prior studies have concluded that people with a pre-existing cardiac disease during pregnancy have favorable outcomes in pregnancy from a cardiovascular standpoint but are at increased risk of other neonatal and obstetric complications. 10 , 18 Our findings corroborate these conclusions from previous, smaller studies of pre-existing IHD in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“… 18 To summarize, prior studies have concluded that people with a pre-existing cardiac disease during pregnancy have favorable outcomes in pregnancy from a cardiovascular standpoint but are at increased risk of other neonatal and obstetric complications. 10 , 18 Our findings corroborate these conclusions from previous, smaller studies of pre-existing IHD in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Pre-Existing Ischemic Heart Disease on Severe Maternal Morbidity and Mortality During Delivery Hospitalizations

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Pre-Existing Ischemic Heart Disease on Severe Maternal Morbidity and Mortality During Delivery Hospitalizations

et al. 2022

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“…Previous reports have shown that most pregnancies are uneventful, although serious adverse events have been reported [ 136 ]. The multidisciplinary team should participate in counseling and monitoring of future high-risk pregnant women [ 137 ]. If the patient decides on contraception, the preferred contraceptive options are partner sterilization, tubal ligation, or intrauterine devices [ 138 ].…”

Section: Managementmentioning

confidence: 99%

MINOCA: One Size Fits All? Probably Not—A Review of Etiology, Investigation, and Treatment

Oliveira

Correia²,

Nicz³

et al. 2022

JCM

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Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of conditions that include both atherosclerotic (coronary plaque disruption) and non-atherosclerotic (spontaneous coronary artery dissection, coronary artery spasm, coronary artery embolism, coronary microvascular dysfunction, and supply–demand mismatch) causes resulting in myocardial damage that is not due to obstructive coronary artery disease. Failure to identify the underlying cause may result in inadequate and inappropriate therapy in these patients. The cornerstone of managing MINOCA patients is to identify the underlying mechanism to achieve the target treatment. Intravascular imaging is able to identify different morphologic features of coronary plaques, while cardiac magnetic resonance is the gold standard for detection of myocardial infarction in the setting of MINOCA. In this review, we summarize the relevant clinical issues, contemporary diagnosis, and treatment options of MINOCA.

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“…Pregnant women are three to four times more likely to suffer an MI than non-pregnant women, with a much higher incidence in those older than 40 years [8]. A history of coronary artery disease is associated with hypertensive disorders of pregnancy, such as pre-eclampsia [9], which are in turn associated with an increased risk of MI (OR 1.6, 95% CI 1.0-2.5) [10]. Physiological changes of pregnancy include an increased cardiac output with left ventricular remodeling [11] and diastolic dysfunction [12], prompting speculation that cTn may be elevated in women with uncomplicated pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Cardiac-specific troponins in uncomplicated pregnancy and pre-eclampsia: A systematic review

et al. 2021

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Background The risk of myocardial infarction (MI) increases during pregnancy, particularly in women with pre-eclampsia. MI is diagnosed by measuring high blood levels of cardiac-specific troponin (cTn), although this may be elevated in women with pre-eclampsia without MI, which increases diagnostic uncertainty. It is unclear how much cTn is elevated in uncomplicated and complicated pregnancy, which may affect whether the existing reference intervals can be used in pregnant women. Previous reviews have not investigated high-sensitivity troponin in pregnancy, compared to older, less sensitive methods. Methods Electronic searches using the terms “troponin I” or “troponin T”, and “pregnancy”, “pregnancy complications” or “obstetrics”. cTn levels were extracted from studies of women with uncomplicated pregnancies or pre-eclampsia. Results The search identified ten studies with 1581 women. Eight studies used contemporary methods that may be too insensitive to use reliably in this clinical setting. Two studies used high-sensitivity assays, with one reporting an elevation in troponin I (TnI) in pre-eclampsia compared to uncomplicated pregnancy, and the other only examining women with pre-eclampsia. Seven studies compared cTn between women with pre-eclampsia or uncomplicated pregnancy using any assay. Seven studies showed elevated TnI in pre-eclampsia compared to uncomplicated pregnancy or non-pregnant women. One study measured troponin T (TnT) in pregnancy but did not examine pre-eclampsia. Conclusion TnI appears to be elevated in pre-eclampsia, irrespective of methodology, which may reflect the role of cardiac stress in this condition. TnI may be similar in healthy pregnant and non-pregnant women, but we found no literature reporting pregnancy-specific reference intervals using high-sensitivity tests. This limits broader application of cTn in pregnancy. There is a need to define reference intervals for cTn in pregnant women, which should involve serial sampling throughout pregnancy, with careful consideration for gestational age and body mass index, which cause dynamic changes in normal maternal physiology.

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Maternal and neonatal outcomes in women with history of coronary artery disease

Cited by 14 publications

References 29 publications

Impact of Pre-Existing Ischemic Heart Disease on Severe Maternal Morbidity and Mortality During Delivery Hospitalizations

Impact of Pre-Existing Ischemic Heart Disease on Severe Maternal Morbidity and Mortality During Delivery Hospitalizations

MINOCA: One Size Fits All? Probably Not—A Review of Etiology, Investigation, and Treatment

Cardiac-specific troponins in uncomplicated pregnancy and pre-eclampsia: A systematic review

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