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Pregnant Women With Uncorrected Congenital Heart Disease: Heart Failure and Mortality.
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2019-09-11 , DOI: 10.1016/j.jchf.2019.09.001 Karen Sliwa 1 , Lucia Baris 2 , Christoph Sinning 3 , Elvin Zengin-Sahm 3 , Lina Gumbiene 4 , Israa F Yaseen 5 , Ghada Youssef 6 , Mark Johnson 7 , Hasan Al-Farhan 5 , Malgorzata Lelonek 8 , Roger Hall 9 , Jolien Roos-Hesselink 2
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2019-09-11 , DOI: 10.1016/j.jchf.2019.09.001 Karen Sliwa 1 , Lucia Baris 2 , Christoph Sinning 3 , Elvin Zengin-Sahm 3 , Lina Gumbiene 4 , Israa F Yaseen 5 , Ghada Youssef 6 , Mark Johnson 7 , Hasan Al-Farhan 5 , Malgorzata Lelonek 8 , Roger Hall 9 , Jolien Roos-Hesselink 2
Affiliation
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OBJECTIVES
The purpose of this work was to study maternal and fetal outcomes of women with uncorrected congenital heart disease (CHD).
BACKGROUND
Globally, CHD is an important cause of maternal morbidity and mortality in women reaching reproductive stage. Data are lacking from larger cohorts of women with uncorrected CHD.
METHODS
The 10-year data from the European Society of Cardiology EORP ROPAC (EURObservational Research Programme Registry of Pregnancy and Cardiac disease) registry of women with uncorrected CHD were analyzed.
RESULTS
Of 5,739 pregnancies in 53 countries, 3,295 women had CHD, 1,059 of which were uncorrected cases. Of these, 41.4% were from emerging countries. There were marked differences between the cardiac defects in uncorrected cases versus those in corrected CHD cases with primary shunt lesions (44.7% vs. 32.4%, respectively), valvular abnormalities (33.5% vs. 12.6%, respectively), and Tetralogy of Fallot and pulmonary atresia (0.8% vs. 20.3%, respectively; p < 0.001). In patients with uncorrected CHD, 6.8% were in modified World Health Organization risk class IV, approximately 10% had pulmonary hypertension (PH), and 3% were cyanotic prior to pregnancy. Maternal mortality and heart failure (HF) in the women with uncorrected CHD were 0.7% and 8.7%, respectively. Eisenmenger syndrome was associated with a very high risk of cardiac events (65.5%), maternal mortality (10.3%), and HF (48.3%). Coming from an emerging country was associated with higher pre-pregnancy signs of HF, PH, and cyanosis (p < 0.001) and worse maternal and fetal outcomes, with a 3-fold higher rate of hospital admissions for cardiac events and intrauterine growth retardation (p < 0.001).
CONCLUSIONS
Marked differences between cardiac conditions in pregnant women with uncorrected CHD and those in corrected CHD were found, with a markedly worse outcome, particularly in women with Eisenmenger syndrome and from emerging countries.
中文翻译：
患有未纠正的先天性心脏病的孕妇：心力衰竭和死亡率。
目的这项工作的目的是研究患有未矫正先天性心脏病（CHD）的妇女的母体和胎儿结局。背景技术在全球范围内，冠心病是达到生殖阶段的妇女孕产妇发病率和死亡率的重要原因。尚无校正的冠心病女性的大样本人群缺乏数据。方法分析了来自欧洲心脏病学会EORP ROPAC（妊娠和心脏疾病的欧洲观察研究计划注册机构）注册的未校正CHD妇女的10年数据。结果在53个国家的5,739例怀孕中，有3,295例患有冠心病的妇女，其中1,059例未经纠正。在这些国家中，有41.4％来自新兴国家。未经纠正的病例与患有原发性分流病变的纠正的冠心病病例的心脏缺损之间存在显着差异（44.7％vs. 32.4％，），瓣膜异常（分别为33.5％和12.6％）和法洛四联症和肺动脉闭锁（分别为0.8％和20.3％; p <0.001）。在未经校正的CHD患者中，有6.8％的患者处于世界卫生组织修订的IV级风险中，约10％的患者患有肺动脉高压（PH），而3％的患者在怀孕前发。未校正冠心病的女性的孕产妇死亡率和心力衰竭（HF）分别为0.7％和8.7％。艾森曼格综合征与心脏事件（65.5％），孕产妇死亡率（10.3％）和心衰（48.3％）的风险很高有关。来自新兴国家与HF，PH和紫osis的怀孕前体征（p <0.001）和更差的母婴结局有关，心脏事件和子宫内发育迟缓的住院率高3倍（ p < 0.001）。结论发现未经校正的冠心病孕妇与经校正的冠心病孕妇心脏状况之间存在明显差异，尤其是在患有艾森曼格综合征的妇女和新兴国家中，其心脏状况显着恶化。
更新日期：2019-09-12
中文翻译：
患有未纠正的先天性心脏病的孕妇：心力衰竭和死亡率。
目的这项工作的目的是研究患有未矫正先天性心脏病（CHD）的妇女的母体和胎儿结局。背景技术在全球范围内，冠心病是达到生殖阶段的妇女孕产妇发病率和死亡率的重要原因。尚无校正的冠心病女性的大样本人群缺乏数据。方法分析了来自欧洲心脏病学会EORP ROPAC（妊娠和心脏疾病的欧洲观察研究计划注册机构）注册的未校正CHD妇女的10年数据。结果在53个国家的5,739例怀孕中，有3,295例患有冠心病的妇女，其中1,059例未经纠正。在这些国家中，有41.4％来自新兴国家。未经纠正的病例与患有原发性分流病变的纠正的冠心病病例的心脏缺损之间存在显着差异（44.7％vs. 32.4％，），瓣膜异常（分别为33.5％和12.6％）和法洛四联症和肺动脉闭锁（分别为0.8％和20.3％; p <0.001）。在未经校正的CHD患者中，有6.8％的患者处于世界卫生组织修订的IV级风险中，约10％的患者患有肺动脉高压（PH），而3％的患者在怀孕前发。未校正冠心病的女性的孕产妇死亡率和心力衰竭（HF）分别为0.7％和8.7％。艾森曼格综合征与心脏事件（65.5％），孕产妇死亡率（10.3％）和心衰（48.3％）的风险很高有关。来自新兴国家与HF，PH和紫osis的怀孕前体征（p <0.001）和更差的母婴结局有关，心脏事件和子宫内发育迟缓的住院率高3倍（ p < 0.001）。结论发现未经校正的冠心病孕妇与经校正的冠心病孕妇心脏状况之间存在明显差异，尤其是在患有艾森曼格综合征的妇女和新兴国家中，其心脏状况显着恶化。
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