pregnancy outcomes in dilated cardiomyopathy

7/27/2019 Pregnancy Outcomes in Dilated Cardiomyopathy

1/26

WELCOME TO JOURNAL

PRESENTATION

Presented by:

Dr. Syeda Masuma KawsarMD, 3rd Part Student

Moderator

Dr. Mohammad Ullah

Assistant Professor, Cardiology

NICVD, Dhaka


2/26

Authors:

Jasmine Grewal et al.

American Heart Journal, vol. 55, Issue 1, 2010

Pregnancy Outcomes in Women With

Dilated Cardiomyopathy


3/26

INTRODUCTION

Women with dilated cardiomyopathy (DCM) are at risk for

complications during pregnancy.

However, little is known about cardiac morbidity or risk

stratification in this population.

Counseling about the safety of pregnancy can have a major

impact on prospective mothers, and it is therefore important that

more data be available to help provide appropriate advice about

pregnancy risks to women with a DCM.


4/26

Therefore, the purposes of this study were:

1) To determine adverse outcomes (maternal

cardiac, obstetric, and fetal and/or neonatal)

during pregnancy in women with dilated

cardiomyopathy (DCM).

2) To compare their cardiac outcomes with those

of nonpregnant women with DCM.

contd


5/26

METHODS

This was a prospective cohort study.

Period of study: December 1994 to July 2008.

Study group: 36 women with DCM.

Control group:18 nonpregnant women with

DCM.


6/26

Inclusion criteria

Women with previously documented

idiopathic or doxorubicin induced DCM with

moderate or severe LV dysfunction (LVEF


7/26

Exclusion criteria

Patients with DCM with mild left ventricular

systolic dysfunction.

Patients with other causes of dilated

cardiomyopathy excluding idiopathic or

doxorubicin induced DCM .


8/26

Baseline data and follow-upAll pregnant women were followed up

prospectively from the start of pregnancy until 6

months post-partum.Nonpregnant women werefollowed up for an equal length of time (16 months).

Clinical, electrocardiographic, and

echocardiographic data were collected at the time

of clinic visits.


9/26

These baseline data were recorded

Age

Co morbid medical conditions

Smoking history New York Heart Association (NYHA) functional

class

Cardiac events (heart failure, transient ischemicattack, arrhythmias).

Prior cardiac interventions

Use of cardiac medications and

Anticoagulation .


10/26

Baseline data and follow-up (contd..).

In the group of pregnant women, additional

baseline data were recorded: gestational age and

parity status.

Obstetric risk factors associated with adverse fetal

and/or neonatal events.

Echocardiographic assessment included left and

right ventricular systolic function, valvular

function, and systolic pulmonary artery pressure .


11/26

Outcomes

Adverse events during the antepartum,

peripartum, and post-partum periods were

classified as :

1. Cardiac

2. Fetal and/or neonatal and

3. Obstetric.


12/26

Outcomes (contd..).

Adverse cardiac events for both pregnant women and

nonpregnant control subjects were defined as:

1) Pulmonary edema2) Sustained symptomatic tachyarrhythmia or

bradyarrhythmia

3) Angina, or myocardial infarction

4) Cardiac arrest or cardiac death.


13/26

Fetal and neonatal complications were defined

as:

1. Premature birth

2. Small-for-gestational-age

3. Respiratory distress syndrome

4. Intraventricular hemorrhage5. Fetal death, or neonatal death.

Obstetric complications were :

1. Maternal death from noncardiac causes

2. Pregnancy-induced hypertension or

3. Post-partum hemorrhage.


14/26

ResultsTotal 36 pregnancies.

32 women with DCM

84% (n = 27) with idiopathic DCM

16% (n = 5) with doxorubicin-induced

cardiomyopathy. 4 women had an episode of heart failure before pregnancy:

(2 had mild, 1 had moderate, and 1had severe LV

systolic dysfunction).

At the time of post-partum discharge:3 (9%) women were in NYHA functional class II,

1 (3%) was in class IV, and

The remainder were in class I.


15/26


16/26

Maternal cardiac outcomes.seventeen of 36 (39%) pregnancies in women with a DCM

were complicated by at least 1 adverse maternal cardiac

event (Table 2).


17/26

Obstetric and fetal/neonatal outcomes

The 36 pregnancies

resulted in 35 live

births, including 1 twin

and 1 triplet pregnancy( 1 pregnancy ended in

theraputic abortion)

(Table 4).


18/26

Comparisons of cardiac outcomes in pregnant versus

nonpregnant women with significant LV systolic

dysfunction.

Three nonpregnant women (17%) had events during

the 16-month follow-up period:1. Cardiac transplantation caused by refractory heart

failure (n= 1),

2. Death secondary to ventricular tachycardia (n = 1), and

3. Syncope secondary to ventricular tachycardia (n= 1).


19/26

In women with moderate or severe LV systolicdysfunction, adverse cardiac events were more common

in pregnant women compared with nonpregnant women

with a DCM (72% [13 of 18] vs. 17% [3 of 18]).

The 16-month event-free survival was worse in pregnant

women compared with nonpregnant women (28 11%

vs. 83 10%, p=0.02) (Fig. 3).

(


20/26

(contd..)


21/26

Discussion

Maternal cardiac complications were

considerable(39%) in women with moderate or severe

LV systolic dysfunction and/or NYHA functionalclass III or IV symptoms. The most common

complication was heart failure, and this typically

occurred late in the pregnancy or post-partum.


22/26

Adverse fetal and/or neonatal events were

highest(20%) in this group of women.

Pregnancy seemed to have a negative impact

on the clinical course of DCM because adverse

cardiac events were more common in pregnant

women compared with nonpregnant women

with DCM.

Discussion (contd..).


23/26

Some studies have shown a transient decrease

in LV contractility during pregnancy and this

may also play a role in cardiac decompensationin women with abnormal LV function.

Results of this study also show thatpregnancyin women with DCM directly impacts the

natural course of the disease.

Discussion (contd..).


24/26

Study limitations

A referral bias may exist because women with less severe

heart disease or those doing well during pregnancy may not

have been referred.

Small sample size, this study was not powered to identifymultiple predictors of outcomes.

Longer-term follow-up was not the focus of this study, but

would be valuable in understanding the long-term effects of

pregnancy on the diseased heart.


25/26

Conclusions

In pregnant women with DCM, clinical parameters,

including NYHA functional class and LV systolic function,

can be used to identify women at highest risk for cardiac

complications during pregnancy. When compared with nonpregnant women,pregnancy

seems to have a negative impact on the clinical course for

women with DCM, at least over the short term.

Fetal and/or neonatal complications are also increased

in mothers with DCM, and the risk is magnified by the

presence of both cardiac and obstetric risk factors.


26/26

THANK YOU

pregnancy outcomes in dilated cardiomyopathy

Documents