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Langen I, Langesæter E, Gunnes N, Almaas VM, Haugen G, Estensen M, Sørbye IK. Hypertensive disorders of pregnancy among women with cardiovascular disease in Norway: A historical cohort study. Acta Obstet Gynecol Scand 2024; 103:1457-1465. [PMID: 38597240 PMCID: PMC11168262 DOI: 10.1111/aogs.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Women with cardiovascular disease may be at increased risk of hypertensive disorders of pregnancy (HDP). We aimed to: (1) Investigate the occurrence of HDP in a cohort of pregnant women with cardiovascular disease and compare it with the occurrence in the general population. (2) Assess the association between maternal cardiovascular risk and risk of HDP. MATERIAL AND METHODS We reviewed clinical data on a cohort of 901 pregnancies among 708 women with cardiovascular disease who were followed at the National Unit for Pregnancy and Heart Disease and gave birth at Oslo University Hospital between 2003 and 2018. The exposure under study was maternal cardiovascular risk, classified as low, moderate, or high based on a modified classification by the World Health Organization. The main outcome of interest was HDP, which included pre-eclampsia and gestational hypertension. The proportion of HDP cases in the general population in the same period was extracted from the Medical Birth Registry of Norway. We used logistic regression to estimate crude and adjusted odds ratios (OR) of HDP, with associated 95% confidence intervals (CIs), for women with moderate- and high cardiovascular risk compared to women with low risk. RESULTS The occurrence of HDP in the study cohort was 12.1% (95% CI: 10.0%-14.4%) and varied between 8.7% (95% CI: 6.5%-11.3%) in the low-risk group, 15.7% (95% CI: 11.1%-21.4%) in the moderate-risk group, and 22.2% (95% CI: 15.1%-30.8%) in the high-risk group. By contrast, the nationwide occurrence of HDP was 5.1% (95% CI: 5.1%-5.2%). In the study cohort, the proportions of pregnancies with gestational hypertension and pre-eclampsia were similar (6.3% and 5.8%, respectively). Compared to pregnancies with low cardiovascular risk, the adjusted OR of HDP was 2.04 (95% CI: 1.21-3.44) in the moderate-risk group and 2.99 (95% CI: 1.73-5.18) in the high-risk group. CONCLUSIONS The occurrence of hypertensive disease of pregnancy in the study cohort was more than doubled compared to the general population in Norway. The risk of HDP increased with maternal cardiovascular risk group. We recommend taking into account maternal cardiovascular risk group when assessing risk and prophylaxis of HDP.
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Affiliation(s)
- Ingrid Langen
- Department of Obstetrics, Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Eldrid Langesæter
- Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
| | - Nina Gunnes
- Norwegian Research Center for Women's HealthOslo University HospitalOsloNorway
| | - Vibeke Marie Almaas
- Department of Cardiology, Division of Cardiovascular and Pulmonary DiseasesOslo University HospitalOsloNorway
| | - Guttorm Haugen
- Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Fetal Medicine, Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
| | - Mette‐Elise Estensen
- Department of Cardiology, Division of Cardiovascular and Pulmonary DiseasesOslo University HospitalOsloNorway
| | - Ingvil Krarup Sørbye
- Department of Obstetrics, Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
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Guzmán-Delgado NE, Velázquez-Sotelo CE, Fernández-Gómez MJ, González-Barrera LG, Muñiz-García A, Sánchez-Sotelo VM, Carranza-Rosales P, Hernández-Juárez A, Morán-Martínez J, Martínez-Gaytan V. Adverse cardiovascular, obstetric and perinatal events during pregnancy and puerperium in patients with heart disease. Rev Clin Esp 2024; 224:337-345. [PMID: 38697610 DOI: 10.1016/j.rceng.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND OBJECTIVES cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. MATERIALS AND METHODS Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. RESULTS 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, p = 0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, p = 0.001) and heart failure (adjusted OR 16; 95% CI: 3-84, p = 0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, p = 0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, p = 0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, p = 0.021). CONCLUSIONS severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.
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Affiliation(s)
- N E Guzmán-Delgado
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Posgrado en Especialidades Médicas, Universidad de Monterrey. San Pedro Garza, García, Nuevo León, Mexico
| | - C E Velázquez-Sotelo
- Departamento de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Posgrado en Especialidades Médicas, Universidad de Monterrey. San Pedro Garza, García, Nuevo León, Mexico.
| | - M J Fernández-Gómez
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - L G González-Barrera
- Departamento de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - A Muñiz-García
- Departamento de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Posgrado en Especialidades Médicas, Universidad de Monterrey. San Pedro Garza, García, Nuevo León, Mexico
| | - V M Sánchez-Sotelo
- Departamento de Cirugía Cardiotorácica, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - P Carranza-Rosales
- Centro de investigación Biomédica del Noreste. Instituto Mexicano del Seguro Social. Monterrey, Nuevo León, Mexico
| | - A Hernández-Juárez
- Departamento de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Posgrado en Especialidades Médicas, Universidad de Monterrey. San Pedro Garza, García, Nuevo León, Mexico
| | - J Morán-Martínez
- Departamento de Biología Celular y Ultraestructura, Facultad de Medicina, Universidad Autónoma de Coahuila unidad Torreón, Torreón, Coahuila, Mexico
| | - V Martínez-Gaytan
- División de Investigación en Salud, Unidad Médica de Alta Especialidad de Gineco Obstetricia No.23, Dr. Ignacio Morones Prieto, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
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3
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Ghisi GLDM, Banks L, Cotie LM, Pakosh M, Pollock C, Nerenberg K, Gagliardi A, Smith G, Colella TJ. Women's Knowledge of Future Cardiovascular Risk Associated With Complications of Pregnancy: A Systematic Review. CJC Open 2024; 6:182-194. [PMID: 38487070 PMCID: PMC10935684 DOI: 10.1016/j.cjco.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 03/17/2024] Open
Abstract
Background Several common pregnancy conditions significantly increase a woman's risk of future cardiovascular diseases (CVD). Patient education and interventions aimed at awareness and self-management of cardiovascular risk factors may help modify future cardiovascular risk. The aim of this systematic review was to examine education interventions for cardiovascular risk after pregnancy, clinical measures/scales, and knowledge outcomes in published qualitative and quantitative studies. Methods Five databases were searched (from inception to June 2023). Studies including interventions and validated and nonvalidated measures of awareness/knowledge of future cardiovascular risk among women after complications of pregnancy were considered. Quality was rated using the Mixed Methods Appraisal Tool. Results were analyzed using the Synthesis Without Meta-analysis reporting guideline. Characteristics of interventions were reported using the Template for Intervention Description and Replication. Fifteen studies were included; 3 were randomized controlled trials. Results In total, 1623 women had a recent or past diagnosis of hypertensive disorders of pregnancy, gestational diabetes mellitus, and/or premature birth. Of the 7 studies that used online surveys or questionnaires, 2 reported assessing psychometric properties of tools. Four studies used diverse educational interventions (pamphlets, information sheets, in-person group sessions, and an online platform with health coaching). Overall, women had a low level of knowledge about their future CVD risk. Interventions were effective in increasing this knowledge. Conclusions In conclusion, women have a low level of knowledge of risk of CVD after pregnancy complications. To increase this level of knowledge and self-management, this population has a strong need for psychometrically validated tailored education interventions.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Laura Banks
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Lisa M. Cotie
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, KITE, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Courtney Pollock
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Departments of Medicine, Obstetrics & Gynecology, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anna Gagliardi
- Toronto General Hospital Research Institute and University of Toronto, Toronto, Ontario, Canada
| | - Graeme Smith
- Department of Obstetrics & Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Tracey J.F. Colella
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, KITE, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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4
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Smirnova A, Aliberti F, Cavaliere C, Gatti I, Vilardo V, Giorgianni C, Cassani C, Repetto A, Narula N, Giuliani L, Urtis M, Ozaki Y, Prati F, Arbustini E, Ferrari M. Spontaneous coronary artery dissection: an unpredictable event. Eur Heart J Suppl 2023; 25:B7-B11. [PMID: 37091648 PMCID: PMC10120938 DOI: 10.1093/eurheartjsupp/suad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of acute coronary syndrome that predominantly affects women in adulthood and is the leading cause of acute myocardial infarction in pregnancy. The most common clinical presentation is ST-segment elevation myocardial infarction (STEMI) or non-STEMI, followed by cardiogenic shock (∼2%), sudden cardiac death (0.8% in autopsy series), cardiac arrest, ventricular arrhythmias (∼5%), and Takotsubo syndrome. The prevalence of SCAD in the general population is largely uncertain due to underdiagnosis. Oral contraceptives, post-menopausal therapy, and infertility treatments are recognized associated factors. The pathological substrates (fibromuscular dysplasia) and triggers (especially emotional stress) are commonly present in affected women. The few cases with a precise genetic aetiology occur in the context of syndromic and non-syndromic connective tissue diseases. The only true certainty in SCAD is the overwhelming prevalence in women. The first event as well as the recurrence (up to 30%, which varies depending on the definition) is largely unpredictable. The treatment strategy is highly individualized and requires extensive additional study in order to optimize outcomes and prevent major adverse cardiovascular events in affected individuals. We have known about SCAD for nearly a century, but we still do not know how best to prevent, diagnose, and treat it, making SCAD a highly important and unmet clinical need.
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Affiliation(s)
- Alexandra Smirnova
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Flaminia Aliberti
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Cavaliere
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Gatti
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Viviana Vilardo
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmelina Giorgianni
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Obstetrics and Gynecology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Alessandra Repetto
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Nupoor Narula
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Lorenzo Giuliani
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mario Urtis
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Francesco Prati
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
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5
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Mittal S, Alsbrook D, Okwechime RT, Iqbal F, Nobleza COS. The landscape of disparities in obstetric neurocritical care and a path forward. Front Neurol 2023; 13:1008544. [PMID: 36686512 PMCID: PMC9853894 DOI: 10.3389/fneur.2022.1008544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Health disparities in the obstetric population affect maternal morbidity and mortality. In the past years, there has been no significant improvement in disparities in care in the obstetric population. Patients who are pregnant are known to have a higher risk of pregnancy-associated neurologic conditions such as stroke and intracerebral hemorrhage. They can also experience concomitant neurocritical care disease states such as status epilepticus and traumatic brain injury. Studies exploring the disparities of care among pregnant patients who are neurotically ill are lacking. We aim to provide the landscape of disparities of care among the obstetric neurocritically-ill population and provide potential actionable opportunities to address these disparities in care.
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Affiliation(s)
- Shilipi Mittal
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Diana Alsbrook
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Remi T. Okwechime
- NeuroMedicine ICU, Critical Care Program University of Rochester Medical Center, Rochester, NY, United States
| | - Farhana Iqbal
- Maimonides Medical Center, Brooklyn, NY, United States
| | - Christa O'Hana S. Nobleza
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States,Baptist Memorial Hospital/Baptist Medical Group, Memphis, TN, United States,*Correspondence: Christa O'Hana S. Nobleza ✉
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6
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Lucà F, Colivicchi F, Parrini I, Russo MG, Di Fusco SA, Ceravolo R, Riccio C, Favilli S, Rossini R, Gelsomino S, Oliva F, Gulizia MM. The role of the pregnancy heart team in clinical practice. Front Cardiovasc Med 2023; 10:1135294. [PMID: 37139137 PMCID: PMC10150137 DOI: 10.3389/fcvm.2023.1135294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Significant maternal and fetal morbidity and mortality risk has been shown to be associated with cardiovascular disease in pregnancy. Several determinants, such as the increasing number of females with corrected congenital heart disease in reproductive age, a more advanced maternal age associated with cardiovascular risk factors, and a greater prevalence of preexisting comorbidities related to cardiac disorders such as cancer and COVID-19), lead to a higher incidence of cardiac complications in pregnancy in the last few decades. However, adopting a multidisciplinary strategy may influence maternal and neonatal outcomes. This review aims at assessing the role of the Pregnancy Heart Team, which should ensure careful pre-pregnancy counseling, pregnancy monitoring, and delivery planning for both congenital and other cardiac or metabolic disorders, addressing several emerging aspects in the multidisciplinary team-based approach.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, Reggio Calabria, Italy
- Correspondence: Fabiana Lucà
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy
| | - Iris Parrini
- Cardiology Department, Mauriziano Hospital, Torino, Italy
| | - Maria Giovanna Russo
- U.O.C. Cardiologia e UTIC Pediatrica, AORN dei Colli, Ospedale Monaldi, Università Della Campania “L. Vanvitelli”, Napoli, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy
| | | | - Carmine Riccio
- Cardiovascular Department, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - Silvia Favilli
- Department of Pediatric Cardiology, Meyer Hospital, Florence, Italy
| | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands
| | - Fabrizio Oliva
- Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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7
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Malhamé I, Czuzoj-Shulman N, Abenhaim HA. Cardiovascular Severe Maternal Morbidity and Mortality at Delivery in the United States: A Population-Based Study. JACC. ADVANCES 2022; 1:100121. [PMID: 38939708 PMCID: PMC11198321 DOI: 10.1016/j.jacadv.2022.100121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/12/2022] [Accepted: 08/27/2022] [Indexed: 06/29/2024]
Abstract
Background Cardiovascular conditions are the leading cause of maternal mortality in North America. Objectives The purpose of this study was to examine the relationship between cardiovascular severe maternal morbidity (CSMM) and mortality during delivery hospitalization. Methods We performed a cohort study using the Health Care Cost and Utilization Project, Nationwide Inpatient Sample, and identified delivery hospitalizations with CSMM from 1999 to 2015. We described temporal trends in the incidence of CSMM and its associated case-fatality. Among individuals with CSMM, we evaluated the association between participant characteristics and mortality using logistic regression analyses. Results Of 13,791,605 delivery hospitalizations, 11,152 were complicated by CSMM. Of those, 495 resulted in mortality. The overall incidence of CSMM was 8.09 per 10,000 delivery hospitalizations (95% CI: 7.94-8.24), increasing from 7.76 to 8.38 per 10,000 delivery hospitalizations over 15 years (P < 0.001). The overall case-fatality for CSMM was 4.44 per 100 CSMM (95% CI: 4.06-4.85), decreasing from 6.55 to 2.50 per 100 CSMM events over the study period (P = 0.035). Among participants with CSMM, Black (adjusted odds ratio [aOR]: 1.80; 95% CI: 1.39-2.32) and Hispanic (aOR: 1.44; 95% CI: 1.09-1.90) women and those with Medicaid insurance (aOR: 1.52; 95% CI: 1.22-1.88), postpartum hemorrhage (aOR: 4.06; 95% CI: 3.05-5.41), or systemic lupus erythematosus (aOR: 2.50; 95% CI: 1.31-4.78) were at increased risk of mortality. Conclusions The incidence of CSMM increased over 15 years, reflecting transformations within the obstetric population. Although it decreased during the study period, case-fatality from CSMM remained elevated. Several factors associated with mortality from CSMM were identified.
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Affiliation(s)
- Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Czuzoj-Shulman
- Department of Obstetrics and Gynaecology, Jewish General Hospital, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady David Research Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Haim A. Abenhaim
- Department of Obstetrics and Gynaecology, Jewish General Hospital, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady David Research Institute of the Jewish General Hospital, Montreal, Quebec, Canada
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8
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Mikail N, Rossi A, Bengs S, Haider A, Stähli BE, Portmann A, Imperiale A, Treyer V, Meisel A, Pazhenkottil AP, Messerli M, Regitz-Zagrosek V, Kaufmann PA, Buechel RR, Gebhard C. Imaging of heart disease in women: review and case presentation. Eur J Nucl Med Mol Imaging 2022; 50:130-159. [PMID: 35974185 PMCID: PMC9668806 DOI: 10.1007/s00259-022-05914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging - Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, Strasbourg, France.,Molecular Imaging - DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Charité, Universitätsmedizin, Berlin, Berlin, Germany.,University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland. .,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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Malhamé I, Raker CA, Hardy EJ, Spalding H, Bouvier BA, Hurlburt H, Vrees R, Daskalopoulou SS, Nerenberg K, Savitz DA, Mehta N, Danilack VA. Development and Internal Validation of a Risk Prediction Model for Acute Cardiovascular Morbidity in Preeclampsia. Can J Cardiol 2022; 38:1591-1599. [PMID: 35709932 DOI: 10.1016/j.cjca.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Persons with preeclampsia are at increased short-term risk of adverse cardiovascular outcomes during pregnancy and the early postpartum period. We aimed to develop and internally validate a risk assessment tool to predict acute cardiovascular morbidity in preeclampsia. METHODS The study was conducted at an academic obstetric hospital. Participants with preeclampsia at delivery between 2007 and 2017 were included. A model to predict acute cardiovascular morbidity at delivery and within 6 weeks postpartum was developed and evaluated. The primary composite outcome included pulmonary edema/acute heart failure, myocardial infarction, aneurysm, cardiac arrest/ventricular fibrillation, heart failure/arrest during surgery or procedure, cerebrovascular disorders, cardiogenic shock, conversion of cardiac rhythm, and difficult-to-control severe hypertension. We assessed model discrimination and calibration. We used bootstrapping for internal validation. RESULTS 4,171 participants with preeclampsia were included. The final model comprised 8 variables. Predictors positively associated with acute cardiovascular morbidity (presented as odds ratio [OR] with 95% confidence interval [CI]) were: gestational age at delivery (20-36 weeks 5.36 [3.67, 7.82]; 37-38 weeks 1.75 [1.16, 2.64]), maternal age (≥40 years 1.65 [1.00, 2.72]; 35-39 years 1.49 [1.07, 2.09]), and prior cesarean delivery (1.47, [1.01, 2.13]). The model had an area under the receiver operating characteristic curve of 0.72 (95% CI [0.69, 0.74]). Moreover, it was adequately calibrated and performed well on internal validation. CONCLUSIONS This risk prediction tool identified women with preeclampsia at highest risk of acute cardiovascular morbidity. If externally validated, this tool may facilitate early interventions aimed at preventing adverse cardiovascular outcomes in pregnancy and postpartum.
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Affiliation(s)
- Isabelle Malhamé
- Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada; Research institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Christina A Raker
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island, USA
| | - Erica J Hardy
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Hannah Spalding
- Department of Medicine, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Benjamin A Bouvier
- Department of Medicine, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Heather Hurlburt
- Department of Medicine, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Roxanne Vrees
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island, USA
| | - Stella S Daskalopoulou
- Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada; Research institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Kara Nerenberg
- Departments of Medicine, Obstetrics & Gynecology, and Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A Savitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island, USA; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Niharika Mehta
- Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Valery A Danilack
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island, USA; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
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Liu SF, Zhao YN, Jia CW, Ma TY, Cai SD, Gao F. Spontaneous dissection of proximal left main coronary artery in a healthy adolescent presenting with syncope: A case report. World J Clin Cases 2022; 10:2341-2350. [PMID: 35321168 PMCID: PMC8895162 DOI: 10.12998/wjcc.v10.i7.2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/29/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a frequent cause of acute coronary syndrome in young to middle-aged women with few or no traditional cardiovascular risk factors. Chest pain is the most frequently described presenting symptom, but syncope is extremely rare. Herein, we report on a 16-year-old girl who presented with an episode of syncope occurring during a race. Despite significantly elevated troponin level, the diagnosis of the left main coronary artery SCAD with cardiogenic shock was delayed.
CASE SUMMARY A 16-year-old girl presented with an episode of syncope. Myocardial injury markers were positive. Echocardiography showed a mildly reduced left ventricular ejection fraction (50%). Although initially stable, she later experienced recurrent chest pain accompanying precordial ST segment elevation with dynamic changes and developed cardiogenic shock, necessitating emergent revascularization. Coronary angiography demonstrated almost total occlusion at the ostium and proximal segment of the left main trunk coronary artery (LMT). Intravascular ultrasound confirmed a false lumen with prominent dissection in the LMT. Percutaneous coronary intervention assisted by intra-aortic balloon pump was conducted in the LMT. A 3.5 mm × 24 mm everolimus-eluting stent was deployed to the focal lesions of the LMT. A postprocedural electrocardiogram showed alleviation of the precordial ST-segment elevation. The diagnosis of SCAD was confirmed. Transthoracic echocardiography showed an improved left ventricular ejection fraction (57%). The patient was asymptomatic during the 24-mo. follow-up period.
CONCLUSION SCAD should always be considered in the differential diagnosis of acute coronary syndrome presentations in low-risk patients, regardless of age.
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Affiliation(s)
- Sui-Feng Liu
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Ya-Nan Zhao
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Chun-Wen Jia
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Tian-Yi Ma
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Shi-Da Cai
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Feng Gao
- Department of Cardiology, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
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