1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 2UKE Hamburg Klinik und Poliklinik für Geburtshilfe und Pränatalmedizin Hamburg, Deutschland
Background and Introduction
An increasing number of patients with congenital heart defects reach reproductive age. This contributes to the observation, that cardiovascular diseases constitute the leading cause of death in women during and after pregnancy in western countries.
Aim of this study is to describe the occurrence of cardiovascular events in patients with cardiovascular disease and the presence of pregnancy. In addition, we aim to define cardiac imaging reference ranges
Methods
The PREG-CVD-HH study is a prospective single-center study of the University Heart and Vascular Center Hamburg currently including 72 pregnant women with cardiac disease.
All patients underwent conventional and two-dimensional strain speckle-tracking
echocardiography. A maternal cardiac event was defined as cardiac death, arrhythmia, heart failure and hospitalization for other cardiac intervention. During pregnancy 10 women without any cardiovascular disease were also recruited as controls. All women underwent cardiac assessment at baseline and were afterwards followed serially throughout pregnancy and until 6 and 12 months postpartum.
Results
The median age of individuals was 34.0 years. Most of the women had a congenital heart disease (N=41), 10 patients developed a pregnancy associated heart disease (preeclampsia, arrhythmia, peripartum cardiomyopathy) and 12 women were included with an acquired heart disease before pregnancy (valve disease, arrhythmia, cardiomyopathy) Heart failure occurred in 13.6% (N=10). Arrhythmias developed five and preeclampsia three of the patients during pregnancy. Hospitalization due cardiovascular events occurred in 16.4% patients. No mortality was shown over the study period. Left ventricular global longitudinal strain (LV GLS) and right ventricular global longitudinal (RV GLS) strain show a transient worsening in the third trimester and peripartum (Figure 1).
Conclusion
In our study a hemodynamic redistribution occurs especially in the third trimester and during delivery. Longitudinal strain of the left and right ventricle decreases. These temporal changes would probably reflect the pathophysiological alterations related to pregnancy. Reference ranges in echocardiography measurements in the pregnant cardiac population are limited und require further investigation, ideally assessed by a “Heart Pregnancy Team” in future.