University of Toronto Pregnancy and Heart Disease Research Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada.
Heart. 2010 Oct;96(20):1656-61. doi: 10.1136/hrt.2010.202838.
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.
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.
A tertiary care referral hospital.
The outcomes of 405 pregnancies were studied (318 women; median follow-up 2.6 years).
LCE included cardiac death/arrest, pulmonary oedema, arrhythmia or stroke.
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).
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.
患有先天性心脏病（CHD）的女性在怀孕期间有发生不良心脏事件的风险；然而，妊娠后晚期（晚期心脏事件；LCE）发生事件的风险尚未得到很好的研究。本研究旨在调查在大量 CHD 女性患者中 LCE 的发生频率和决定因素。
前瞻性记录基线特征和妊娠情况。通过病历回顾确定 LCE（分娩后>6 个月）。生存分析用于确定 LCE 的危险因素。
三级保健转诊医院。
研究了 405 例妊娠的结局（318 名女性；中位随访 2.6 年）。
LCE 包括心源性死亡/骤停、肺水肿、心律失常或中风。
在 12%（50/405）例妊娠后发生 LCE。妊娠期间发生不良心脏事件的女性 LCE 发生率高于未发生者（27±9%比 15±3%，HR 2.2，p=0.02）。LCE 风险最高的女性是那些有功能障碍/发绀（HR 3.9，95%CI 1.2 至 13.0）、主动脉下室功能障碍（HR 3.0，95%CI 1.4 至 6.6）、肺动脉瓣下室功能障碍和/或严重肺反流（HR 3.2，95%CI 1.6 至 6.6）、左心梗阻（HR 2.6，95%CI 1.2 至 5.2）和妊娠前或妊娠期间的心脏事件（HR 2.6，95%CI 1.3 至 4.9）的女性。在无、1 个或>1 个风险预测因子的女性中，LCE 的 5 年发生率分别为 7±2%、23±5%和 44±10%（p<0.001）。
在患有 CHD 的女性中，妊娠前的母体特征有助于识别发生 LCE 风险增加的女性。妊娠期间发生不良心脏事件很重要，并且与 LCE 风险增加相关。
