TY - JOUR
T1 - Cardiac Complications in Pregnant Women With Isolated Mitral Stenosis and Their Association With Echocardiographic Changes During Pregnancy
AU - Wichert-Schmitt, Barbara
AU - Steckham, Katherine Elizabeth
AU - Pfaller, Birgit
AU - Colman, Jack Marc
AU - Wald, Rachel Maya
AU - Sermer, Mathew
AU - Mason, Jennifer
AU - Siu, Samuel Chi Bun
AU - Silversides, Candice Kristeen
N1 - Funding Information:
This study was supported by a grant from the Allan E. Tiffin Trust (Toronto General & Western Hospital Foundation) . Dr. Silversides is supported by the Miles Nadal chair in Pregnancy and Heart Disease (Mount Sinai Hospital) .
Publisher Copyright:
© 2021
PY - 2021/11/1
Y1 - 2021/11/1
N2 - In women with mitral stenosis (MS), mitral valve gradients and right ventricular systolic pressure (RVSP) can increase in response to the physiologic stress of pregnancy. The prognostic significance of these echocardiographic changes has not been well studied. Pregnancy outcomes and serial echocardiograms were collected in women with MS prospectively recruited as part of a larger study on pregnancy outcomes. Third trimester echocardiograms were compared with baseline echocardiograms. Changes in mitral valve area (MVA), transmitral mean gradient (MG), and RVSP during pregnancy and their relationship to adverse cardiac events (CE) were examined. Fifty-six pregnancies in 47 women with MS were included. The MVA did not change during pregnancy (1.6 ± 0.6 cm2 at baseline vs 1.7 ± 0.6 cm2 in the third trimester, p = 0.46). There was an increase in the MG (8 ± 3 vs 11 ± 6 mm Hg, p <0.001) and the RVSP (39 ± 14 vs 47 ± 20 mm Hg, p <0.001) during the third trimester. Adverse CE occurred in 45% (25/56) of pregnancies. CE were associated with baseline MG>10 mm Hg, baseline RVSP >40 mm Hg, third-trimester MG>10 mm Hg, and RVSP >40 mm Hg. Women with mitral valve MG ≤10 mm Hg who had a normal RVSP at baseline and in the third trimester were at lowest risk for CE (11%) with a negative predictive value of 89%. In conclusion, baseline echocardiographic assessment of MS severity as well as changing echocardiographic parameters during pregnancy can help identify women at risk for cardiac complications during pregnancy.
AB - In women with mitral stenosis (MS), mitral valve gradients and right ventricular systolic pressure (RVSP) can increase in response to the physiologic stress of pregnancy. The prognostic significance of these echocardiographic changes has not been well studied. Pregnancy outcomes and serial echocardiograms were collected in women with MS prospectively recruited as part of a larger study on pregnancy outcomes. Third trimester echocardiograms were compared with baseline echocardiograms. Changes in mitral valve area (MVA), transmitral mean gradient (MG), and RVSP during pregnancy and their relationship to adverse cardiac events (CE) were examined. Fifty-six pregnancies in 47 women with MS were included. The MVA did not change during pregnancy (1.6 ± 0.6 cm2 at baseline vs 1.7 ± 0.6 cm2 in the third trimester, p = 0.46). There was an increase in the MG (8 ± 3 vs 11 ± 6 mm Hg, p <0.001) and the RVSP (39 ± 14 vs 47 ± 20 mm Hg, p <0.001) during the third trimester. Adverse CE occurred in 45% (25/56) of pregnancies. CE were associated with baseline MG>10 mm Hg, baseline RVSP >40 mm Hg, third-trimester MG>10 mm Hg, and RVSP >40 mm Hg. Women with mitral valve MG ≤10 mm Hg who had a normal RVSP at baseline and in the third trimester were at lowest risk for CE (11%) with a negative predictive value of 89%. In conclusion, baseline echocardiographic assessment of MS severity as well as changing echocardiographic parameters during pregnancy can help identify women at risk for cardiac complications during pregnancy.
KW - Adult
KW - Blood Pressure
KW - Echocardiography
KW - Female
KW - Humans
KW - Mitral Valve Stenosis/complications
KW - Pregnancy
KW - Pregnancy Complications, Cardiovascular/diagnostic imaging
KW - Retrospective Studies
KW - Ventricular Function, Right/physiology
UR - http://www.scopus.com/inward/record.url?scp=85114698491&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2021.07.037
DO - 10.1016/j.amjcard.2021.07.037
M3 - Journal article
C2 - 34509293
SN - 0002-9149
VL - 158
SP - 81
EP - 89
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -