Marlies A M Kampman1, Ali Balci2, Henk Groen3, Arie P J van Dijk4, Jolien W Roos-Hesselink5, Joost P van Melle6, Krystyna M Sollie-Szarynska7, Elly M C J Wajon8, Barbara J M Mulder9, Dirk J van Veldhuisen6, Petronella G Pieper10. 1. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; The Netherlands Heart Institute (ICIN), Utrecht, the Netherlands. 2. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Cardiology, Isala, Zwolle, the Netherlands. 3. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 4. Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands. 5. Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, the Netherlands. 6. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 7. Department of Gynaecology and Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 8. Department of Cardiology, Medical Spectrum Twente, Enschede, the Netherlands. 9. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 10. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: p.g.pieper@umcg.nl.
Abstract
BACKGROUND: Pregnancy is increasingly common in women with congenital heart disease (CHD), but little is known about long-term cardiovascular outcome after pregnancy in these patients. We studied the incidence of cardiovascular events 1-year postpartum and compared cardiac function prepregnancy and 1-year postpartum in women with CHD. METHODS: From our national, prospective multicenter cohort study, 172 women were studied. Follow-up with clinical evaluation and echocardiography and NT-proBNP measurement were performed during pregnancy and 12 months postpartum. Cardiovascular events were defined as need for an urgent invasive cardiovascular procedure, heart failure, arrhythmia, thromboembolic events, myocardial infarction, cardiac arrest, cardiac death, endocarditis, and aortic dissection. RESULTS: Cardiovascular events were observed after 11 pregnancies (6.4%). Women with cardiovascular events postpartum had significant higher NT-proBNP values at 20-week gestation (191 [137-288] vs 102.5 [57-167]; P = .049) and 1-year postpartum compared with women without cardiovascular events postpartum (306 [129-592] vs 105 [54-187] pg/mL; P = .014). Women with cardiovascular events during pregnancy were at higher risk for late cardiovascular events (HR 7.1; 95% CI 2.0-25.3; P = .003). In women with cardiovascular events during pregnancy, subpulmonary end-diastolic diameter had significantly increased 1-year postpartum (39.0 [36.0-48.0] to 44.0 [40.0-50.0]; P = .028). No other significant differences were found in cardiac function or size 1-year postpartum compared with preconception values. CONCLUSIONS: Cardiovascular events are relatively rare 1 year after pregnancy in women with CHD. Women with cardiovascular events during pregnancy are prone to develop cardiovascular events 1-year postpartum and have increased subpulmonary ventricular diameter compared with preconception values.
BACKGROUND: Pregnancy is increasingly common in women with congenital heart disease (CHD), but little is known about long-term cardiovascular outcome after pregnancy in these patients. We studied the incidence of cardiovascular events 1-year postpartum and compared cardiac function prepregnancy and 1-year postpartum in women with CHD. METHODS: From our national, prospective multicenter cohort study, 172 women were studied. Follow-up with clinical evaluation and echocardiography and NT-proBNP measurement were performed during pregnancy and 12 months postpartum. Cardiovascular events were defined as need for an urgent invasive cardiovascular procedure, heart failure, arrhythmia, thromboembolic events, myocardial infarction, cardiac arrest, cardiac death, endocarditis, and aortic dissection. RESULTS: Cardiovascular events were observed after 11 pregnancies (6.4%). Women with cardiovascular events postpartum had significant higher NT-proBNP values at 20-week gestation (191 [137-288] vs 102.5 [57-167]; P = .049) and 1-year postpartum compared with women without cardiovascular events postpartum (306 [129-592] vs 105 [54-187] pg/mL; P = .014). Women with cardiovascular events during pregnancy were at higher risk for late cardiovascular events (HR 7.1; 95% CI 2.0-25.3; P = .003). In women with cardiovascular events during pregnancy, subpulmonary end-diastolic diameter had significantly increased 1-year postpartum (39.0 [36.0-48.0] to 44.0 [40.0-50.0]; P = .028). No other significant differences were found in cardiac function or size 1-year postpartum compared with preconception values. CONCLUSIONS: Cardiovascular events are relatively rare 1 year after pregnancy in women with CHD. Women with cardiovascular events during pregnancy are prone to develop cardiovascular events 1-year postpartum and have increased subpulmonary ventricular diameter compared with preconception values.