Pregnancy in Women With Impaired Left Ventricular Function: Data From ROPAC

Area of Science:

• Cardiology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Pregnancy imposes significant hemodynamic stress, particularly challenging for women with pre-existing heart disease.
• Impaired left ventricular function (LVF), defined as ejection fraction <40%, presents a high-risk profile during gestation.

Purpose of the Study:

• To investigate the cardiac, obstetric, and fetal outcomes in pregnant women diagnosed with impaired LVF.
• To identify risk factors associated with adverse outcomes in this high-risk population.

Main Methods:

• Analysis of a prospective, international observational cohort (ROPAC) of 251 pregnant women with impaired LVF.
• Primary endpoint: Major Adverse Cardiac Events (MACE), including mortality, arrhythmias, heart failure, and thromboembolic events.
• Logistic regression used to identify predictors of poor outcomes.

Main Results:

• Maternal mortality was 2.4%, with heart failure occurring in 27% and ventricular tachyarrhythmias in 4% of patients.
• 32% of patients experienced at least one MACE during pregnancy or postpartum.
• Obstetric complications included preterm birth (27%) and low birthweight (26%).
• Cardiomyopathy patients faced higher risks: 4.3% mortality and ~40% MACE risk.
• Pre-pregnancy heart failure symptoms, atrial fibrillation, and NYHA class >II predicted poor cardiac outcomes.

Conclusions:

• Women with impaired LVF face elevated risks of heart failure, tachyarrhythmias, and premature delivery with low birth weight.
• Early identification of risk factors like heart failure symptoms and arrhythmias is critical for management.