Pregnancy in Women With Impaired Left Ventricular Function

BackgroundThe hemodynamic changes during pregnancy can be challenging in women with underlying heart disease, particularly in women with impaired left ventricular function (LVF, left ventricular ejection fraction <40%).ObjectivesThe aim of this study was to describe the cardiac, obstetric, and fetal outcomes of pregnancy in women with impaired LVF.MethodsROPAC (Registry Of Pregnancy and Cardiac disease) includes an international, prospective, observational cohort of pregnancies in women with heart disease. Cardiac, obstetric, and fetal outcomes were analyzed in 251 patients with impaired LVF. The primary endpoint was the occurrence of major adverse cardiac events (MACE) including maternal death, supraventricular or ventricular arrhythmias, heart failure, aortic dissection, endocarditis, ischemic coronary event, and other thromboembolic events. Logistic regression was used to determine variables associated with poor outcomes.ResultsMedian follow-up duration was 7 (6-11) months. Maternal mortality occurred in 6/251 (2.4%, 1%-5%) and heart failure in 67/251 (27%, 21%-33%) patients. Ventricular tachyarrhythmias occurred in 11/251 (4%, 2%-8%) patients. Eighty-one of 251 (32%, 27%-38%) patients experienced at least one MACE during pregnancy or up to 6 months postpartum. Obstetric complications were common, including preterm birth in 67/251 (27%, 22%-33%) and low birthweight in 65/251 (26%, 21%-32%). Patients with cardiomyopathy were at higher risk of cardiovascular complications with 4.3% mortality and nearly 40% risk of MACE during pregnancy. Prepregnancy signs of heart failure (OR: 2.67; 1.3-5.6), atrial fibrillation (OR: 6.32; 3.0-13.3), and an NYHA functional class >II (OR: 6.06; 2.2-16.6) were associated with poor cardiac outcomes.ConclusionsWomen with impaired LVF are at increased risk of complications, particularly heart failure, tachyarrhythmias, and premature delivery with low birth weight.