School of Medicine, University of California, San Francisco, California, USA.
Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, California, USA.
Open Heart. 2023 Sep;10(2). doi: 10.1136/openhrt-2023-002430.
Patients with congenital heart disease (CHD) are increasingly pursuing pregnancy, highlighting the need for data on late cardiovascular events (more than 6 months after delivery). We aimed to determine the incidence of late cardiovascular events in postpartum patients with CHD and evaluate the accuracy of the existing risk scores in predicting these events.
We identified patients with CHD who delivered between 2008 and 2020 at a tertiary centre and had follow-up data for greater than 6 months post partum. Late cardiovascular events were defined as heart failure, arrhythmia, thromboembolic events, endocarditis, urgent cardiovascular interventions or death. Survival analysis and Cox proportional model were used to estimate the incidence of late cardiovascular events and determine the hazard ratio of factors associated with these events.
Of 117 patients, 19% had 36 late cardiovascular events over a median follow-up of 3.8 years. Annual incidence of any late cardiovascular event was 5.7%. Hazards of late cardiovascular events were significantly higher among those with higher Cardiac Disease in Pregnancy Study (CARPREG) II and Zwangerschap bij Aangeboren HARtAfwijking-Pregnancy in Women With Congenital Heart Disease (ZAHARA) risk scores and among patients with prepregnancy New York Heart Association class≥II. C-statistic to predict the late cardiovascular events was highest for ZAHARA (0.7823), followed by CARPREG II (0.6902) and prepregnancy New York Heart Association class≥ II (0.6677).
Currently available risk tools designed for prognostication during the peripartum period can also be used to determine risks of late maternal cardiovascular events among those with CHD. These findings provide important new information for counselling and risk modification.
患有先天性心脏病 (CHD) 的患者越来越多地追求妊娠，这突显了需要了解产后 6 个月以上的晚期心血管事件的数据。我们旨在确定产后 CHD 患者晚期心血管事件的发生率，并评估现有风险评分预测这些事件的准确性。
我们在一家三级中心确定了 2008 年至 2020 年间分娩且产后随访时间超过 6 个月的 CHD 患者。晚期心血管事件定义为心力衰竭、心律失常、血栓栓塞事件、心内膜炎、紧急心血管介入或死亡。生存分析和 Cox 比例模型用于估计晚期心血管事件的发生率，并确定与这些事件相关的因素的危险比。
在 117 名患者中，19%的患者在中位随访 3.8 年后发生了 36 例晚期心血管事件。任何晚期心血管事件的年发生率为 5.7%。在 CARPREG II 和 Zwangerschap bij Aangeboren HARtAfwijking-Pregnancy in Women With Congenital Heart Disease (ZAHARA) 风险评分较高的患者以及在妊娠前纽约心脏协会分级≥II 级的患者中，晚期心血管事件的危险比显著更高。预测晚期心血管事件的 ZAHARA 评分最高（0.7823），其次是 CARPREG II（0.6902）和妊娠前纽约心脏协会分级≥ II 级（0.6677）。
目前用于围产期预后的风险工具也可用于确定 CHD 患者晚期产妇心血管事件的风险。这些发现为咨询和风险修正提供了重要的新信息。
