Characterization of cardiac arrhythmias and maternal-fetal outcomes in pregnant women: A prospective cohort study.

INTRODUCTION AND OBJECTIVES: Cardiovascular disease is a common cause of morbidity and mortality in pregnant women. Arrhythmias are common complications during pregnancy; however, the data are limited. Our goal was to characterize the epidemiology, clinical presentation, and impact of cardiac arrhythmias on maternal-fetal outcomes. METHODS: A prospective cohort study from the Colombian Registry of Pregnancy and Cardiovascular Disease was carried out from 2016 to 2019. All patients with tachyarrhythmia or bradyarrhythmia and a minimum follow-up of six months after delivery were included. The primary outcome was a composite of cardiac events defined as pulmonary edema, symptomatic sustained arrhythmia requiring specific therapy, stroke, cardiac arrest, or maternal death. Secondary outcomes were other cardiac, neonatal, and obstetric events. RESULTS: Arrhythmias were the most common cause of referral to our dedicated cardio-obstetric clinic. A total of 92 patients were included, mean age 27±6 years; 8.7% had previous structural heart disease, and cardiology consultation was delayed in 79.4%. The most common arrhythmias were premature ventricular contractions (33%) and paroxysmal reentrant supraventricular tachycardias (15%); 11 patients (12%) had cardiac implantable electronic devices. Cardiac events occurred in 18.4% of patients, obstetric events occurred in 6.5%, and one caesarean was indicated in the context of symptomatic severe mitral stenosis. Adverse neonatal outcomes were observed in 24.3% of newborns. CONCLUSIONS: Arrhythmias were the most common cause of referral to a dedicated cardio-obstetric clinic; most had a benign course. Adverse maternal cardiovascular outcomes were significant and there was a high rate of obstetric and neonatal adverse events, underlining the importance of multidisciplinary care.

Validación de los modelos de predicción de desenlaces cardiacos adversos CARPREG II (Cardiac Disease in Pregnancy) y clasificación modificada de la Organización Mundial de la Salud (OMS) en gestantes con cardiopatía / Validation of the CARPREG II risk stratification model and the WHO scale in pregnant women with heart disease

Resumen Introducción: En gestantes con cardiopatía, los modelos de estratificación del riesgo de desenlaces adversos permiten guiar las decisiones clínicas y establecer estrategias de seguimiento y manejo de acuerdo con cada categoría. Objetivo: Validar los modelos de predicción de riesgo de desenlaces cardiacos adversos CARPREG II y OMSm en gestantes con cardiopatía. Materiales y método: Estudio de validación y comparación de dos modelos de predicción de riesgo en una cohorte prospectiva de gestantes con cardiopatía, valoradas por un equipo cardioobstétrico en un país de ingresos medios. Se evaluaron los desenlaces cardiovasculares y perinatales y se determinó la calibración y el nivel de discriminación de estas herramientas. Resultados: Entre 328 gestantes (27 años DE = 7), el 33% (n = 110) tenían cardiopatía congénita, el 30% (n = 98) arritmias, el 14% (n = 46) valvulopatías y el 9% (n = 29) miocardiopatía. Un evento cardiaco ocurrió en el 15% (10% primario y 5% secundario). La discriminación de ambos modelos fue adecuada (AUC-ROC: 0.74; IC 95%: 0.64-0.84 para CARPREG II y 0.77 para OMSm; IC 95%: 0.69-0.86). La calibración también es buena (Hosmer-Lemeshow > 0.05). Las variables numéricas fracción de eyección y presión sistólica de la arteria pulmonar, pueden mejorar la capacidad de predicción del CARPREG II. Conclusiones: Los modelos CARPREG II y OMSm tienen buena capacidad de predicción del riesgo de desenlaces cardiacos adversos y se ajustan a nuestras gestantes con cardiopatía.

Abstract Introduction: In pregnant women with heart disease, risk stratification models for adverse outcomes allow guiding clinical decisions and establish monitoring and management strategies according to each category. Objective: To validate CARPREG II and WHOm adverse cardiac outcome risk prediction models in this population. Materials and methods: Validation and comparison study of two risk prediction models in a prospective cohort of pregnant women with heart disease, assessed by a team cardio-obstetrician in a middle-income country. We assessed cardiovascular and perinatal outcomes and determined the calibration and level of discrimination of these tools. Results: Among 328 pregnant women (27 years SD = 7), 33% (n = 110) had congenital heart disease, 30% (n = 98) arrhythmias, 14% (n = 46) valvular pathologies and 9% (n = 29) cardiomyopathies. A cardiac event occurred in 15% (10% primary and 5% secondary). Discrimination of both models was adequate (AUC-ROC 0.74 CI 95% 0.64-0.84 for CARPREG II and 0.77 for WHOm 95% CI 0.69-0.86). The calibration is also good (Hosmer-Lemeshow >0.05). The Numerical variables of fraction of ejection and systolic pressure of the pulmonary artery can improve the predictive ability of CARPREG II. Conclusions: The CARPREG II and WHOm risk stratification models have good ability to predict the risk of adverse cardiac outcomes and are adjusted to our pregnant women with heart disease.