Lima Fabio V, Yang Jie, Xu Jianjin, Stergiopoulos Kathleen
Division of Cardiovascular Medicine, Department of Medicine, State University of New York, Stony Brook University Medical Center, Stony Brook, New York; Department of Medicine, Brown University, Rhode Island Hospital, Providence, Rhode Island.
Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York.
Am J Cardiol. 2017 May 15;119(10):1694-1700. doi: 10.1016/j.amjcard.2017.02.003. Epub 2017 Feb 28.
Investigation of trends and outcomes in heart disease (HD) and pregnancy has been limited. We chose to identify the prevalence, trends, and outcomes of pregnant women with different forms of HD in the United States. Healthcare Cost and Utilization Project's National Inpatient Sample was screened for hospital admissions for delivery in pregnant women with HD from 2003 to 2012. Maternal clinical characteristics and outcomes were identified in women with and without HD, and in HD subtypes: congenital (CHD), valvular HD, cardiomyopathy, and pulmonary hypertension (PH). Primary outcomes of interest were prevalence, trends, and major adverse cardiac events (MACEs), a composite of in-hospital death, acute myocardial infarction, heart failure, arrhythmia, cerebrovascular event, embolic events, or cardiac complications of anesthesia. We studied 81,295 patients with HD and 39,894,032 without. CHD was the most frequent type (41.8%, 33,982 of 81,295 patients), followed by valvular HD (30.9%, 25,138 of 81,295 patients), cardiomyopathy (20.8%, 16,926 of 81,295 patients), and PH (6.5%, 5,250 of 81,295 patients). MACE was highest among women with cardiomyopathy and lowest among women with CHD (44.0%, 7,449 of 16,926 vs 6.2%, 2,102 of 33,982; p <0.0001). PH patients had the highest in-hospital death, followed by cardiomyopathy patients (1.0%, 51 of 5,250 and 0.7%, 124 of 16,926, respectively). Pregnant women with HD significantly increased by 24.7%, related to increases in cardiomyopathy, CHD, and PH from 2003 to 2012. MACE significantly increased by 18.8%. In conclusion, pregnancy in women with HD is increasing, particularly for high risk conditions such as cardiomyopathy and PH. There is a significant and gradual increase in MACE for women with HD.
对心脏病（HD）与妊娠的趋势及结局的研究一直很有限。我们选择确定美国患有不同形式HD的孕妇的患病率、趋势及结局。对医疗成本与利用项目的全国住院患者样本进行筛查，以找出2003年至2012年患有HD的孕妇的分娩住院情况。确定了患有和未患有HD的女性以及HD亚型（先天性心脏病（CHD）、瓣膜性心脏病、心肌病和肺动脉高压（PH））患者的孕产妇临床特征及结局。感兴趣的主要结局为患病率、趋势及主要不良心脏事件（MACE），MACE是一个综合指标，包括住院死亡、急性心肌梗死、心力衰竭、心律失常、脑血管事件、栓塞事件或麻醉相关心脏并发症。我们研究了81295例患有HD的患者和39894032例未患HD的患者。CHD是最常见的类型（41.8%，81295例患者中的33982例），其次是瓣膜性心脏病（30.9%，81295例患者中的25138例）、心肌病（20.8%，81295例患者中的16926例）和PH（6.5%，81295例患者中的5250例）。MACE在心肌病患者中最高，在CHD患者中最低（44.0%，16926例中的7449例 vs 6.2%，33982例中的2102例；p<0.0001）。PH患者的住院死亡率最高，其次是心肌病患者（分别为1.0%，5250例中的51例和0.7%，16926例中的124例）。从2003年到2012年，患有HD的孕妇显著增加了24.7%，这与心肌病、CHD和PH的增加有关。MACE显著增加了18.8%。总之，患有HD的女性怀孕的情况正在增加，尤其是对于心肌病和PH等高风险情况。患有HD的女性的MACE有显著且逐渐增加的趋势。
