Key result
TR velocity >3.4 m/s, RA >50 mm, and NYHA III-IV are linked to maternal CCU transfer.
Why the study?
The study was designed to explore factors affecting pregnancy outcomes in patients with pulmonary hypertension and to create a predictive model to guide decisions on continuing pregnancy.
Observational (n=158)
No
Echocardiographic markers of right heart structural changes, particularly tricuspid regurgitation velocity and right atrial diameter, are significant predictors of adverse maternal and neonatal outcomes in pregnant patients with pulmonary hypertension.
These markers may flag high-risk pregnancies for closer monitoring; hypothesis-generating for prospective validation in pulmonary hypertension.
OBJECTIVE: The purpose of this study is to explore the factors affecting the pregnancy outcome of patients with pulmonary hypertension, and to design a digital model predicting the pregnancy outcome of patients and judge whether patients have the conditions to continue pregnancy. METHODS: The clinical data of patients with pregnancy complicated with pulmonary hypertension hospitalized in Guangdong Provincial People's Hospital from January 1, 2014 to December 31, 2020 were retrospectively analyzed. The severity of pulmonary hypertension, the structural and functional indexes measured by echocardiography were compared, and the effects on maternal and neonatal outcomes were analyzed. RESULTS: A total of 158 patients met the inclusion and exclusion criteria. The results showed that tricuspid regurgitation velocity (P<0.001), right ventricular diameter (P<0.05), right atrial diameter (P<0.05), pulmonary artery diameter (P<0.001) and cardiac function classification (P<0.001) were risk factors for maternal outcomes; Tricuspid regurgitation velocity (P<0.001) and structural changes of right heart were risk factors for neonatal outcomes. By multivariate logistic regression analysis, tricuspid regurgitation velocity (P<0.001), cardiac function (P<0.05) and superior inferior diameter of right atrium (P<0.05) were significant risk factors for maternal outcomes, while tricuspid regurgitation velocity (P<0.001) and superior inferior diameter of right atrium (P<0.05) were significant risk factors for neonatal outcomes. Using significant risk factors, a risk score system was established to predict the pregnancy outcome. CONCLUSION: in this study, we analyzed the clinical data of patients with pregnancy complicated with pulmonary hypertension in our hospital in recent years, and found that the changes of right heart structure (the acceleration of tricuspid regurgitation velocity, and the increase of right atrium, right ventricular diameter, right ventricular outflow tract anteroposterior diameter and main pulmonary artery diameter), are influencing factors of pregnancy outcomes in patients with pulmonary hypertension. In addition, we preliminarily designed a risk score through multi factor analysis, which is helpful to predict the possible outcome of puerperium and neonatal outcomes of patients, and to provide some reference for clinicians and patients to make decisions on whether to continue pregnancy in clinical practice.
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Zhao et al. (2022) conducted an observational in Pregnancy complicated with pulmonary hypertension (n=158). Tricuspid regurgitation velocity > 3.4 m/s vs. Tricuspid regurgitation velocity ≤ 3.4 m/s was evaluated on Maternal transfer to the cardiac care unit (CCU) (Beta -2.776, 95% CI -3.927 to -1.626, p=0.001). Tricuspid regurgitation velocity >3.4 m/s, right atrial diameter >50 mm, and NYHA class III-IV were identified as significant risk factors for maternal transfer to the cardiac care unit.
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