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Pregnancy increased risk of adverse events in women with dilated cardiomyopathy
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Several clinical characteristics may help physicians determine the likelihood of negative cardiac events among pregnant women with dilated cardiomyopathy, study results suggested.
Researchers enrolled 32 women with dilated cardiomyopathy from a larger prospective cohort study of 906 women with heart disease. There were a total of 36 pregnancies, 27 (84%) of whom had idiopathic cardiomyopathy and five (16%) of whom had doxorubicin-induced cardiomyopathy.
According to the study results, 14 of the 36 pregnancies in women with dilated cardiomyopathy were complicated by at least one adverse maternal cardiac event. One woman experienced HF and ventricular tachycardia. Four women experienced either AF or atrial flutter during the antepartum period and one during labor. Heart failure occurred in three pregnancies during the antepartum period, one pregnancy during labor and delivery and in four pregnancies during the postpartum period. A transient ischemic attack occurred in one woman at 19 weeks gestation.
After performing multivariate analysis, the researchers reported that left ventricular systolic dysfunction and/or New York Hear Association (NYHA) functional class III and IV were the main determinants of adverse maternal cardiac events during pregnancy (P=.003). All women who experienced adverse cardiac events during pregnancy had either moderate to severe LV dysfunction, NYHA functional class III or IV and/or a previous cardiac event; there were no adverse events in women with none of the three clinical parameters. Sixteen-month event-free survival was worse in pregnant women vs. nonpregnant women (P=.02).
“In pregnant women with dilated cardiomyopathy, clinical parameters, including NYHA functional class and LV systolic dysfunction can be used to identify women at highest risk for cardiac complications during pregnancy,” the researchers concluded. “When compared with nonpregnant women, pregnancy seems to have a negative impact on the clinical course for women with dilated cardiomyopathy, at least over the short term. Fetal and/or neonatal complications are also increased in mothers with dilated cardiomyopathy, and the risk is magnified by the presence of both cardiac and obstetric risk factors.”
Grewal J. J Am Coll Cardiol. 2009;55:45-52.