Department of Obstetrics and Gynecology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
BMC Pregnancy Childbirth. 2024 Mar 20;24(1):211. doi: 10.1186/s12884-024-06402-5.
BACKGROUND: Although pregnancy-associated heart failure with preserved ejection fraction (HFpEF) is increasing and contributing to maternal morbidity, little is known about its impact on pregnancy. We examined the risk factors for and adverse pregnancy outcomes of HFpEF in pregnant women. METHODS: We conducted a cross-sectional analysis of pregnancy-related hospitalizations from 2009 to 2020 using the perinatal database of seven multicenters. Cases of HFpEF were identified using the International Classification of Diseases and echocardiography findings. The patients were categorized into the HFpEF and control groups. Risk factors were evaluated using multivariate logistic regression analysis to generate odds ratios (OR) and 95% confidence intervals (CI). Furthermore, adjusted associations between HFpEF and adverse pregnancy outcomes were determined. Risk scores for the stratification of women at a high risk of HFpEF were calculated using a statistical scoring model. RESULTS: Of the 34,392 women identified, 258 (0.76%) were included in the HFpEF group. In multivariate analysis, HFpEF was significantly associated with old maternal age (OR, 1.04; 95% CI 1.02-1.07), multiple pregnancy (OR, 2.22; 95% CI 1.53-3.23), rheumatic disease (OR, 2.56; 95% CI 1.54-4.26), pregnancy induce hypertension (OR 6.02; 95% CI 3.61-10.05), preeclampsia (OR 24.66; 95% CI 18.61-32.66), eclampsia or superimposed preeclampsia (OR 32.74; 95% CI 21.60-49.64) and transfusion in previous pregnancy (OR 3.89; 95% CI 1.89-8.01). A scoring model to predict HFpEF with those factors achieved an area under the curve of 0.78 at cutoff value of 3. Women with HFpEF also had increased odds ratios of intensive care unit admission during the perinatal period (odds ratio, 5.98; 95% confidence interval, 4.36-8.21) and of postpartum hemorrhage (odds ratio, 5.98; 95% confidence interval, 2.02-3.64). CONCLUSIONS: Pregnancy-associated HFpEF is associated with adverse pregnancy outcomes. A scoring model may contribute to screening HFpEF using echocardiography and preparing adverse pregnancy outcomes.
背景：尽管与妊娠相关的心衰伴射血分数保留（HFpEF）的发病率不断增加，并导致孕产妇发病率上升，但人们对其妊娠影响知之甚少。本研究旨在探讨妊娠女性 HFpEF 的发病风险因素及不良妊娠结局。
方法：我们采用来自七个中心的围产数据库，对 2009 年至 2020 年期间的妊娠相关住院病例进行了横断面分析。使用国际疾病分类和超声心动图结果确定 HFpEF 病例。将患者分为 HFpEF 组和对照组。采用多变量 logistic 回归分析评估发病风险因素，以生成比值比（OR）和 95%置信区间（CI）。此外，还确定了 HFpEF 与不良妊娠结局之间的调整关联。使用统计学评分模型计算用于 HFpEF 高危女性分层的风险评分。
结果：在纳入的 34392 名女性中，有 258 名（0.76%）被纳入 HFpEF 组。多变量分析显示，HFpEF 与高龄产妇（OR，1.04；95%CI，1.02-1.07）、多胎妊娠（OR，2.22；95%CI，1.53-3.23）、风湿性疾病（OR，2.56；95%CI，1.54-4.26）、妊娠相关性高血压（OR，6.02；95%CI，3.61-10.05）、子痫前期（OR，24.66；95%CI，18.61-32.66）、子痫或子痫前期重叠（OR，32.74；95%CI，21.60-49.64）和既往妊娠输血（OR，3.89；95%CI，1.89-8.01）显著相关。基于这些因素的预测 HFpEF 的评分模型在截断值为 3 时，曲线下面积为 0.78。HFpEF 患者在围产期入住重症监护病房的比值比（OR）也更高（OR，5.98；95%置信区间，4.36-8.21），且产后出血的比值比（OR，5.98；95%置信区间，2.02-3.64）也更高。
结论：与妊娠相关的心衰伴射血分数保留与不良妊娠结局相关。评分模型可能有助于使用超声心动图筛查 HFpEF 并为不良妊娠结局做好准备。
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