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Cardiac outcomes after pregnancy in women with congenital heart disease

2010; BMJ; Volume: 96; Issue: 20 Linguagem: Inglês

10.1136/hrt.2010.202838

1468-201X

Olga Hajnalka Bálint, Samuel C. Siu, Jennifer Mason, Jasmine Grewal, Robert W. Wald, Erwin Oechslin, Boldizsar Kovacs, Mathew Sermer, Jack M. Colman, C. K. Silversides,

Cardiac Arrhythmias and Treatments

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 (>6 months 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.