Management and Outcome of Pregnancy in Non-peripartum Dilated Cardiomyopathy: Results from the Registry On Pregnancy And Cardiac Disease (ROPAC)
2Department of Medicine, Division of Cardiology, USC-LAC Medical Center, Los Angeles, CA
3Cardiology, Erasmus University Medical Center, Rotterdam
4Cardiology, Kaplan Medical Center, Rehovot
5Cardiology, Assaf Harofeh Medical Center, Zerifin
Background: Current guidelines recommend against pregnancy in women with LVEF ≤20% and cautiousness in women with LVEF≤40% due to increased risk of maternal and fetal morbidity and mortality.
Aim: To compare characteristics, management and outcome of pregnant women with LVEF ≤40% in comparison to the rest of the ROPAC population.
Methods: All women included in ROPAC with echo data, excluding GUCH and PPC patients were followed-up for 1-year.
Results: Out of 2,966 pregnant women 1,070 had no ech0. We excluded also 1004 GUCH patients (54 with LVEF≤40%) and 22 PPCM patients (9 with LVEF≤40%). Our cohort included 65 patients with LVEF≤40% and 805 patients with LVEF>40%. The table presents their characteristics and management.
|
LVEF≤40% n=65 |
LVEF>40% n=805 |
p |
|
|
Age |
31 |
29 |
0.025 |
|
Nulliparity |
43% |
34% |
NS |
|
Diagnosis |
|||
|
Cardiomyopathy |
57% |
8% |
|
|
IHD |
9% |
2% |
<0.001 |
|
Valvular |
28% |
80% |
|
|
Hypertension |
19% |
6% |
0.001 |
|
HF signs |
18% |
13% |
NS |
|
During pregnancy |
|||
|
B-blockers |
61% |
24% |
<0.001 |
|
ACE-I |
14% |
1% |
<0.001 |
|
Diuretics |
40% |
14% |
<0.001 |
|
Maternal mortality |
1(1.5%) |
3(0.4%) |
NS |
|
Ventricular arrhythmia |
8% |
1% |
0.003 |
|
C-section |
60% |
52% |
NS |
|
Preterm delivery |
34% |
14% |
<0.001 |
|
Abortion for maternal health |
3.1% |
0.6% |
0.09 |
|
Birth weight <2500gr |
28% |
16% |
0.012 |
The pregnant women with LVEF≤40% had more obstetrical complication, were treated with more HF medications, had more ventricular arrhythmias, but relatively low rate of cardiovascular complication, including one fatal postpartum outcome.
Conclusion: Non-PPCM pregnant women with LVEF≤40% had relatively more obstetrical complications, but overall a low rate of cardiovascular complications in comparison to pregnant women with LVEF>40% (mainly valvular etiology) included in ROPAC.
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