Division of Cardiology, University of Toronto Pregnancy and Heart Disease Research Program, Mount Sinai Hospital/Sinai Health System, and Toronto General Hospital/University Health Network, Toronto, Ontario, Canada; Department of Obstetrics & Gynaecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
J Am Coll Cardiol. 2018 May 29;71(21):2419-2430. doi: 10.1016/j.jacc.2018.02.076.
Identifying women at high risk is an important aspect of care for women with heart disease.
This study sought to: 1) examine cardiac complications during pregnancy and their temporal trends; and 2) derive a risk stratification index.
We prospectively enrolled consecutive pregnant women with heart disease and determined their cardiac outcomes during pregnancy. Temporal trends in complications were examined. A multivariate analysis was performed to identify predictors of cardiac complications and these were incorporated into a new risk index.
In total, 1,938 pregnancies were included. Cardiac complications occurred in 16% of pregnancies and were primarily related to arrhythmias and heart failure. Although the overall rates of cardiac complications during pregnancy did not change over the years, the frequency of pulmonary edema decreased (8% from 1994 to 2001 vs. 4% from 2001 to 2014; p value = 0.012). Ten predictors of maternal cardiac complications were identified: 5 general predictors (prior cardiac events or arrhythmias, poor functional class or cyanosis, high-risk valve disease/left ventricular outflow tract obstruction, systemic ventricular dysfunction, no prior cardiac interventions); 4 lesion-specific predictors (mechanical valves, high-risk aortopathies, pulmonary hypertension, coronary artery disease); and 1 delivery of care predictor (late pregnancy assessment). These 10 predictors were incorporated into a new risk index (CARPREG II [Cardiac Disease in Pregnancy Study]).
Pregnancy in women with heart disease continues to be associated with significant morbidity, although mortality is rare. Prediction of maternal cardiac complications in women with heart disease is enhanced by integration of general, lesion-specific, and delivery of care variables.
识别高危女性是心脏病女性护理的重要方面。
本研究旨在：1）检查妊娠期间的心脏并发症及其时间趋势；2）制定风险分层指数。
我们前瞻性纳入连续患有心脏病的孕妇，并确定其妊娠期间的心脏结局。检查并发症的时间趋势。进行多变量分析以确定心脏并发症的预测因素，并将这些因素纳入新的风险指数。
共纳入 1938 例妊娠。16%的妊娠出现心脏并发症，主要与心律失常和心力衰竭有关。尽管妊娠期间心脏并发症的总体发生率多年来没有变化，但肺水肿的频率有所下降（1994 年至 2001 年为 8%，2001 年至 2014 年为 4%；p 值=0.012）。确定了 10 个母亲心脏并发症的预测因素：5 个一般预测因素（既往心脏事件或心律失常、心功能差或发绀、高危瓣膜病/左心室流出道梗阻、系统性心室功能障碍、无既往心脏介入）；4 个病变特异性预测因素（机械瓣膜、高危主动脉疾病、肺动脉高压、冠状动脉疾病）；和 1 个分娩护理预测因素（妊娠晚期评估）。这 10 个预测因素被纳入一个新的风险指数（CARPREG II [妊娠期间心脏疾病研究]）。
尽管死亡率罕见，但患有心脏病的女性的妊娠仍然与显著的发病率相关。通过整合一般、病变特异性和分娩护理变量，可以提高患有心脏病的女性发生母亲心脏并发症的预测能力。
