Maternal Outcomes Among Pregnant Women With Congenital Heart Disease–Associated Pulmonary Hypertension-猫眼课题宝

先天性心脏病相关肺动脉高压的孕妇的母体结局

DOI：

10.1161/circulationaha.122.057987

发表时间：

2023-02

期刊：

Circulation

影响因子：

37.8

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Qian Zhang;Fang Zhu;Guocheng Shi;Chen Hu;Weituo Zhang;Puzhen Huang;Chunfeng Zhu;H. Gu;Dong Yang;Qiangqiang Li;Yonghua Niu;Hao Chen;Ruixiang Ma;Ziyi Pan;H. Miao;Xin Zhang;Genxia Li;Yabing Tang;Guyuan Qiao;Yichen Yan;Zhongqun Zhu;Hao Zhang;F. Han;Yan-na Li;Jianhua Lin;Huiwen Chen

背景资料：针对孕妇先天性心脏病（CHD）相关肺动脉高压（PH）的研究很少，且受样本量小和单中心设计的限制。本研究旨在描述合并和不合并PH的CHD孕妇的妊娠结局。方法：回顾性评估1993年至2016年7家三级医院CHD孕妇的结局，并前瞻性评估2017年至2019年7家三级医院CHD孕妇的结局。根据超声心动图或导管插入术诊断PH。产妇死亡，心脏并发症，产科和后代并发症的发生率进行了比较，妇女与CHD和无PH，轻度，中度至重度PH. Results：共有2220例孕妇CHD已完成妊娠。在729名女性中确定了与CHD相关的PH，包括398名轻度PH（右心室至右心房梯度30-50 mm Hg）和331名中度至重度PH（右心室至右心房梯度>50 mm Hg）。分别有1例（0.1%）、0例和19例（5.7%）患有CHD和无、轻度或中度至重度PH的妇女发生孕产妇死亡。在729例PH患者中，619例（85%）患有CHD相关的肺动脉高压，110例（15%）患有其他形式的PH。总体而言，轻度PH患者的孕产妇结局优于中度至重度PH患者，包括孕产妇死亡或心力衰竭的发生率（7.8%对39.6%; P100 ng/L（比值比，1.9 [95% CI，1.0-3.4]，P=0.04）和纽约心脏协会III至IV级（比值比，2.9 [95%CI，1.6-5.3]，P<0.001）与妊娠期PH的母亲不良心脏事件独立相关，而多学科小组随访（优势比，0.4 [95%CI，0.2-0.6]，P<0.001）和严格的产前监护（优势比，0.5 [95%CI，0.3-0.7]，P=0.001）具有保护作用。结论：与CHD相关的中度至重度PH的女性相比，CHD相关的轻度PH的女性似乎具有更好的结局，并且CHD和无PH的女性的大多数结局的事件率相似。多模态风险评估，包括PH严重程度、脑钠肽水平和纽约心脏协会分级，可能是有用的危险分层在妊娠期PH。随访与多学科团队和严格的产前监督在怀孕期间也可能有助于减轻不良孕产妇心脏事件的风险。

Background: Studies focused on pregnant women with congenital heart disease (CHD)–associated pulmonary hypertension (PH) are scarce and limited by small sample sizes and single-center design. This study sought to describe the pregnancy outcomes in women with CHD with and without PH. Methods: Outcomes for pregnant women with CHD were evaluated retrospectively from 1993 to 2016 and prospectively from 2017 to 2019 from 7 tertiary hospitals. PH was diagnosed on the basis of echocardiogram or catheterization. The incidence of maternal death, cardiac complications, and obstetric and offspring complications was compared for women with CHD and no PH, mild, and moderate-to-severe PH. Results: A total of 2220 pregnant women with CHD had completed pregnancies. PH associated with CHD was identified in 729 women, including 398 with mild PH (right ventricle to right atrium gradient 30–50 mm Hg) and 331 with moderate-to-severe PH (right ventricle to right atrium gradient >50 mm Hg). Maternal mortality occurred in 1 (0.1%), 0, and 19 (5.7%) women with CHD and no, mild, or moderate-to-severe PH, respectively. Of the 729 patients with PH, 619 (85%) had CHD-associated pulmonary arterial hypertension, and 110 (15%) had other forms of PH. Overall, patients with mild PH had better maternal outcomes than those with moderate-to-severe PH, including the incidence of maternal mortality or heart failure (7.8% versus 39.6%; P100 ng/L (odds ratio, 1.9 [95% CI, 1.0–3.4], P=0.04) and New York Heart Association class III to IV (odds ratio, 2.9 [95% CI, 1.6–5.3], P<0.001) were independently associated with adverse maternal cardiac events in pregnancy with PH, whereas follow-up with a multidisciplinary team (odds ratio, 0.4 [95% CI, 0.2–0.6], P<0.001) and strict antenatal supervision (odds ratio, 0.5 [95% CI, 0.3–0.7], P=0.001) were protective. Conclusions: Women with CHD-associated mild PH appear to have better outcomes compared with women with CHD-associated moderate-to-severe PH, and with event rates similar for most outcomes with women with CHD and no PH. Multimodality risk assessment, including PH severity, brain natriuretic peptide level, and New York Heart Association class, may be useful in risk stratification in pregnancy with PH. Follow-up with a multidisciplinary team and strict antenatal supervision during pregnancy may also help to mitigate the risk of adverse maternal cardiac events.

Maternal Outcomes Among Pregnant Women With Congenital Heart Disease–Associated Pulmonary Hypertension

先天性心脏病相关肺动脉高压的孕妇的母体结局

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