Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India.
Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
Heart. 2020 Sep;106(18):1400-1406. doi: 10.1136/heartjnl-2020-316648. Epub 2020 Jun 29.
To assess the incidence of adverse cardiac events in pregnant women with rheumatic valvular heart disease (RHD) and to derive a clinical risk scoring for predicting it.
This is an observational study involving pregnant women with RHD, attending a tertiary centre in south India. Data regarding obstetric history, medical history, maternal complications and perinatal outcome till discharge were collected. Eight-hundred and twenty pregnancies among 681 women were included in the analysis. Primary outcome was composite adverse cardiac event defined as occurrence of one or more of complications such as death, cardiac arrest, heart failure, cerebrovascular accident from thromboembolism and new-onset arrhythmias.
Of the 681 women with RHD, 180 (26.3%) were diagnosed during pregnancy. Composite adverse cardiac outcome during pregnancy/post partum occurred in 122 (14.9%) pregnancies, with 12 of them succumbed to the disease. In multivariate analysis, prior adverse cardiac events (OR=8.35, 95% CI 3.54 to 19.71), cardiac medications at booking (OR=0.53, 95% CI 0.32 to 0.86), mitral stenosis (mild OR=2.48, 95% CI 1.08 to 5.69; moderate OR=2.23, 95% CI 1.19 to 4.18; severe OR=7.72,95% 4.05 to 12.89), valve replacement (OR=2.53, 95% CI 1.28 to 5.02) and pulmonary hypertension (OR=6.90, 3.81 to 12.46) were predictive of composite adverse cardiac events with a good discrimination (area under the curve=0.803) and acceptable calibration. A predictive score combining these factors is proposed for clinical utility.
Heart failure remains the most common adverse cardiac event during pregnancy or puerperium. Combining the lesion-specific characteristics and clinical information into a predictive score, which is simple and effective, could be used in routine clinical practice.
评估风湿性心脏瓣膜病（RHD）孕妇不良心脏事件的发生率，并得出预测其发生的临床风险评分。
这是一项观察性研究，纳入了在印度南部一家三级中心就诊的患有 RHD 的孕妇。收集了与产科史、病史、产妇并发症和分娩后出院时的围产儿结局相关的数据。共有 681 名女性的 820 次妊娠纳入分析。主要结局为定义为发生一种或多种并发症的复合不良心脏事件，如死亡、心脏骤停、心力衰竭、血栓栓塞性脑血管意外和新发心律失常。
在 681 名患有 RHD 的女性中，180 名（26.3%）在怀孕期间被诊断出患有该疾病。在妊娠/产后期间，共有 122 次妊娠（14.9%）发生了复合不良心脏事件，其中 12 人死于该疾病。多变量分析显示，既往不良心脏事件（OR=8.35，95%CI 3.54 至 19.71）、就诊时使用心脏药物（OR=0.53，95%CI 0.32 至 0.86）、二尖瓣狭窄（轻度 OR=2.48，95%CI 1.08 至 5.69；中度 OR=2.23，95%CI 1.19 至 4.18；重度 OR=7.72，95%CI 4.05 至 12.89）、瓣膜置换（OR=2.53，95%CI 1.28 至 5.02）和肺动脉高压（OR=6.90，95%CI 3.81 至 12.46）与复合不良心脏事件相关，具有良好的鉴别力（曲线下面积=0.803）和可接受的校准。提出了一种结合这些因素的预测评分，用于临床实用。
心力衰竭仍然是妊娠或产褥期最常见的不良心脏事件。将特定病变特征和临床信息结合到一个简单有效的预测评分中，可用于常规临床实践。
