Key result
Prior cardiac events linked to ~8.3-fold higher adverse outcomes in pregnant women with RHD.
Why the study?
The incidence of adverse cardiac events in pregnant women with rheumatic valvular heart disease and a predictive clinical risk score were not well established.
Do prior adverse cardiac events increase the risk of composite adverse cardiac events in pregnant women with rheumatic heart disease?
Observational (n=681)
No
Do prior adverse cardiac events increase the risk of composite adverse cardiac events in pregnant women with rheumatic heart disease?
Identifies key clinical and echocardiographic predictors of adverse maternal cardiac events in pregnant women with rheumatic heart disease, proposing a predictive score for clinical use.
Answers are grounded in this paper and cite their sources.
May inform risk stratification for pregnant women with RHD; leaves open prospective validation of predictive scores.
OBJECTIVE: To assess the incidence of adverse cardiac events in pregnant women with rheumatic valvular heart disease (RHD) and to derive a clinical risk scoring for predicting it. METHODS: This is an observational study involving pregnant women with RHD, attending a tertiary centre in south India. Data regarding obstetric history, medical history, maternal complications and perinatal outcome till discharge were collected. Eight-hundred and twenty pregnancies among 681 women were included in the analysis. Primary outcome was composite adverse cardiac event defined as occurrence of one or more of complications such as death, cardiac arrest, heart failure, cerebrovascular accident from thromboembolism and new-onset arrhythmias. RESULTS: Of the 681 women with RHD, 180 (26.3%) were diagnosed during pregnancy. Composite adverse cardiac outcome during pregnancy/post partum occurred in 122 (14.9%) pregnancies, with 12 of them succumbed to the disease. In multivariate analysis, prior adverse cardiac events (OR=8.35, 95% CI 3.54 to 19.71), cardiac medications at booking (OR=0.53, 95% CI 0.32 to 0.86), mitral stenosis (mild OR=2.48, 95% CI 1.08 to 5.69; moderate OR=2.23, 95% CI 1.19 to 4.18; severe OR=7.72,95% 4.05 to 12.89), valve replacement (OR=2.53, 95% CI 1.28 to 5.02) and pulmonary hypertension (OR=6.90, 3.81 to 12.46) were predictive of composite adverse cardiac events with a good discrimination (area under the curve=0.803) and acceptable calibration. A predictive score combining these factors is proposed for clinical utility. CONCLUSION: Heart failure remains the most common adverse cardiac event during pregnancy or puerperium. Combining the lesion-specific characteristics and clinical information into a predictive score, which is simple and effective, could be used in routine clinical practice.
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Baghel et al. (2020) conducted an observational in Rheumatic valvular heart disease (n=681). Prior adverse cardiac events vs. No prior adverse cardiac events was evaluated on Composite adverse cardiac event (death, cardiac arrest, heart failure, cerebrovascular accident from thromboembolism, and new-onset arrhythmias) (OR 8.35, 95% CI 3.54-19.71). Prior adverse cardiac events strongly predicted composite adverse cardiac outcomes in pregnant women with rheumatic heart disease (OR 8.35, 95% CI 3.54-19.71).
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