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Echocardiographic changes and impact on clinical management in pregnant women with heart disease

Published online by Cambridge University Press:  21 June 2022

Karishma Patel ,
Lidija McGrath Open the ORCID record for Lidija McGrath [Opens in a new window] ,
Paola Roldan ,
Marshall Taunton ,
Kathleen Brookfield ,
Emmanuelle Paré  and
Abigail Khan Open the ORCID record for Abigail Khan [Opens in a new window]
Karishma Patel
Affiliation:
Oregon Health & Science University School of Medicine, Portland, OR, USA
Lidija McGrath
Affiliation:
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
Paola Roldan
Affiliation:
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
Marshall Taunton
Affiliation:
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
Kathleen Brookfield
Affiliation:
Oregon Health & Science University School of Medicine, Portland, OR, USA
Emmanuelle Paré
Affiliation:
Division of Perinatology, Oregon Health & Science University, Portland, OR, USA
Abigail Khan*
Affiliation:
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
*
Author for correspondence: Abigail Khan, MD, MSCE, UHN 62, Knight Cardiovascular Institute, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Tel: +1 503-494-7400; Fax: +1 503-494-8550. E-mail: khaab@ohsu.edu
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Abstract

Background:

While guidelines recommend echocardiography for pregnant women with heart disease, there are limited data on its effect on clinical practice. In this study, we investigated pregnancy-associated echocardiographic changes and their impact on management.

Methods:

This was a retrospective study of pregnant women with heart disease followed at an academic medical centre from 2016 to 2020. Data on maternal intrapartum and postpartum echocardiograms were collected and the impact on management analysed.

Results:

421 echocardiograms in 232 pregnancies were included in the study. The most common cardiac diagnosis was CHD (60.8% of pregnancies), followed by cardiomyopathy (9.9%). The frequency of baseline echocardiographic abnormalities varied by diagnosis, with abnormal right ventricular systolic pressure being the most common (15.0% of pregnancies in CHD and 23.1% of pregnancies with cardiomyopathy). 39.2% of the 189 follow-up echocardiograms had a significant change from the prior study, with the most common changes being declines in right ventricular function (4.2%) or left ventricular function (3.7%), and increases in right ventricular systolic pressure (5.3%) and aortic size (21.2%). 17.8% of echocardiograms resulted in a clinical management change, with the most common change being shorter interval follow-up.

Conclusions:

Echocardiographic changes in pregnant women with heart disease are common, in particular increases in aortic size. Echocardiography results in changes in management in a small but significant proportion of patients. Further studies are needed to determine how other factors, including patient access and resource allocation, factor into the use of echocardiography during pregnancy.

Keywords

Echocardiographypregnancycardiovascular disease
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 3 , March 2023 , pp. 449 - 456
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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