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OBJECTIVE: To investigate fetal/neonatal and obstetric events in pregnancies with both maternal and fetal heart disease. STUDY DESIGN: From the CARPREG database, singleton pregnancies (>24 weeks) in patients with structural heart disease that underwent fetal/neonatal echocardiograms were selected and separated in two groups: maternal heart disease only (M-HD) and maternal and fetal heart disease (MF-HD). Differences in adverse fetal/neonatal (death, preterm birth, and small for gestational age) and obstetric (preeclampsia/eclampsia) outcomes between groups were analyzed. RESULTS: From 1011 pregnancies, 93 had MF-HD. Fetal/neonatal events (38.7% vs 25.3%, p = 0.006) and spontaneous preterm birth (10.8% vs 4.9%, p = 0.021) were more frequent in MF-HD compared to M-HD, with no difference in obstetric events. MF-HD remained as a significant predictor of fetal/neonatal events after adjustment (OR:1.883; 95% CI:1.182-3.000; p = 0.008). CONCLUSIONS: Pregnancies with MF-HD are at risk of adverse fetal/neonatal events and spontaneous preterm birth. Larger studies are needed to determine their association with preeclampsia.
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Background: Patient reported outcomes (PROs) are important measures in acquired heart disease but have not been well defined in Adult Congenital Heart Disease (ACHD). Our aim was to explore the discriminatory capacity of PRO survey tools in Fontan circulatory failure (FCF). Methods: Consecutive adults were enrolled from our ambulatory clinics. Inclusion criteria were age ≥18 years, a Fontan circulation or a hemodynamically insignificant shunt lesion, and sufficient cognitive/language abilities to complete PROs. A comprehensive package of PRO measures, designed to assess perceived health-related quality of life (HRQOL) was administered (including the Kansas City Cardiomyopathy Questionnaire [KCCQ-12], EuroQol-5-dimension [EQ5D], Short Form Health Status Survey [SF-12], self-reported New York Heart Association [NYHA] Functional Class, and Specific Activity Scale [SAS]). Results: We compared 54 Fontan patients (35 ± 10 years) to 25 simple shunt lesion patients (34 ± 11 years). The KCCQ-12 score was lower in Fontan versus shunt lesion patients (87 [IQR 79, 95] versus 100 [IQR 97, 100], p-value < 0.001). The FCF subgroup was associated with lower KCCQ-12 scores as compared with the non-FCF subgroup (82 [IQR 56, 89] versus 93 [IQR 81, 98], p-value = 0.002). Although the KCCQ-12 had the best discriminatory capacity for determination of FCF of all PRO tools studied (c-statistic 0.75 [CI 0.62, 0.88]), superior FCF discrimination was achieved when the KCCQ-12 was combined with all PRO tools (c-statistic 0.82 [CI 0.71, 0.93]). Conclusions: The KCCQ-12 questionnaire demonstrated good discriminatory capacity for the identification of FCF, which was further improved through the addition of complementary PRO tools. Further research will establish the value of PRO tools to guide management strategies in ACHD.
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Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM. Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution. Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.
Subject(s)
COVID-19 , Adult , COVID-19/diagnostic imaging , COVID-19/epidemiology , Female , Hospital Mortality , Humans , Latin America/epidemiology , Male , Middle Aged , Prospective Studies , Registries , SARS-CoV-2 , Tomography, X-Ray Computed/methodsABSTRACT
BACKGROUND: Cardiac diseases complicate 4% of pregnancies, with a mortality rate between 0 and 15%. Early referral has shown to reduce the risk of maternal major cardiac events (MACEs). METHODS: We retrospectively analyzed a cohort of pregnant women with heart disease from two referral centers in Mexico City. We examined MACEs: maternal death, pulmonary edema, acute heart failure, endocarditis, stroke, myocardial infarction, acute aortic syndromes, arrhythmias requiring urgent treatment, and the need for an urgent intervention; preterm birth and obstetric events such as HELLP syndrome, preeclampsia, eclampsia, placental abruption, obstetric hemorrhage. We analyzed the association between each modified World Health Organization (mWHO) group and MACEs, preterm birth and obstetric outcomes between March 2014 and March 2019. RESULTS: Using the mWHO classification, 399 deliveries were included and stratified as follows: I, 162; II, 133; II-III, 21; III, 18; and IV, 52 patients. MACEs were observed in 12.5% of the cohort and were associated with mWHO II (odds ratio [OR], 3.0; 95% confidence interval [95% CI], 1.1-8.1; p = 0.027), II-III (OR, 3.3; 95% CI, 0.9-1.0; p = 0.116), III (OR, 5.3; 95% CI, 1.2-23; p = 0.026), and IV (OR, 8.2; 95% CI, 2.7-24.5; p < 0.001) after adjusting for age, desaturation, previous functional class, and gestational age at referral. An association between mWHO and frequency of preterm birth was observed. Association between mWHO and obstetric events, even when adjusted, was not observed. CONCLUSIONS: The prevalence of MACEs and preterm birth is similar to that seen worldwide; MACEs and preterm birth are associated with the severity of heart disease stratified by mWHO, but there is no association between the severity of heart disease and obstetric events.