Department of Medicine, Division of Cardiovascular Medicine, State University of New York Stony Brook University Medical Center, Stony Brook, NY.
Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY.
J Am Heart Assoc. 2017 Oct 24;6(10):e006144. doi: 10.1161/JAHA.117.006144.
Pregnant women with pulmonary hypertension (PH) are at risk for adverse cardiac outcomes, particularly at the time of labor and delivery. The purpose of this study is to define the impact of PH on pregnancy outcomes and the risk of major adverse cardiac events (MACE).
The National Inpatient Sample was screened for hospital admissions of women delivering during the years 2003 to 2012. The primary outcome was MACE, a composite of death, cardiac arrest, cardiogenic shock, myocardial infarction, respiratory failure, arrhythmia, stroke, and embolic event. Data on 1519 patients with PH and 6 757 582 without heart disease or PH were available. There were 59.6% with isolated PH; 10.7% with PH and congenital heart disease; 18.1% with PH and valvular heart disease; 3% with PH and valvular heart disease and congenital heart disease; 6.6% PH and cardiomyopathy; and 1.9% with PH and cardiomyopathy and valvular heart disease. Compared with women without heart disease or PH, women with PH experienced significantly higher MACE (24.8 versus 0.4%, <0.0001). Among the subsets of women with PH, the highest MACE was noted in women with the combination of PH and cardiomyopathy and valvular heart disease, and PH and cardiomyopathy, primarily because of heart failure and arrhythmia. Women with PH were significantly more likely to experience eclampsia syndromes, preterm delivery, and intrauterine fetal demise (<0.0001 for all). PH subtype was significantly associated with MACE in multivariable analysis (<0.001).
In a contemporary data set of pregnant women in the United States, PH was associated with an increase in MACE during the hospitalization for delivery, with an exceptionally elevated risk among women with associated cardiomyopathy.
患有肺动脉高压（PH）的孕妇存在不良心脏结局的风险，尤其是在分娩和分娩期间。本研究的目的是定义 PH 对妊娠结局和主要不良心脏事件（MACE）的风险的影响。
从 2003 年至 2012 年期间筛选了全国住院患者样本，以寻找分娩期间住院的女性。主要结局是 MACE，由死亡、心脏骤停、心源性休克、心肌梗死、呼吸衰竭、心律失常、中风和栓塞事件组成。有 1519 例 PH 患者和 6757582 例无心脏病或 PH 的患者的数据可用。其中 59.6%为单纯 PH；10.7%为 PH 和先天性心脏病；18.1%为 PH 和瓣膜性心脏病；3%为 PH 和瓣膜性心脏病及先天性心脏病；6.6%为 PH 和心肌病；1.9%为 PH 和心肌病及瓣膜性心脏病。与无心脏病或 PH 的女性相比，患有 PH 的女性发生 MACE 的风险明显更高（24.8%比 0.4%，<0.0001）。在 PH 女性亚组中，PH 合并心肌病和瓣膜性心脏病以及 PH 和心肌病的女性发生 MACE 的风险最高，主要是因为心力衰竭和心律失常。患有 PH 的女性发生子痫前期综合征、早产和宫内胎儿死亡的可能性明显更高（所有 P 值均<0.0001）。多变量分析显示，PH 亚型与 MACE 显著相关（P<0.001）。
在美国当代孕妇数据集中，PH 与分娩住院期间 MACE 的增加相关，而合并相关心肌病的女性风险极高。
