Background Pregnancy leads to physiological changes within the cardiovascular system such as increased plasma volume and cardiac output or hypercoagulability. These changes can be challenging for women with pre-existing cardiovascular disease with higher risks of complications. The guidelines of the European Society of Cardiology recommend treating high-risk patients in specialized centres by an interdisciplinary pregnancy heart team. In a team-based approach, the Pregnancy Heart Team was founded at our university hospital, in order to establish specific structures of communication and responsibility. Methods A prospective registry of all patients treated by the Pregnancy Heart Team between November 2022 and March 2024 was established. Patients consisted of women with pre-existing cardiovascular disease undergoing pregnancy as well as women who developed pregnancy-associated cardiovascular disease. Patients were evaluated throughout pregnancy by lab work and echocardiography during each trimester as well as in the postpartum period. Results In total 39 women (mean age 34±5 years) were prospectively included in the registry. 17 patients (43.5%) were classified as mWHO ≥ III. 17 patients (43.5 %) with pre-existing (pregnancy-associated) cardiovascular disease were managed throughout pregnancy and delivery. 9 patients (18.4 %) developed pregnancy-associated cardiovascular diseases such as peripartum cardiomyopathy or spontaneous coronary artery dissection. Preliminary data shows that mean left-ventricular ejection fraction remained stable during pregnancy with a non-significant trend towards lower values postpartum. Cardiac biomarkers such as high-sensitivity troponin T and NT-pro-BNP showed a non-significant trend towards increased values in the third trimester and postpartum. Adverse maternal outcomes occurred in 14 patients (35.9 %), including preterm premature rupture of membranes (12.2%), gestational hypertension (7.6%), gestational diabetes (5.1%), preeclampsia/eclampsia (7.6%) and delivery-associated complications (10.2%). Fetal complications included macrosomia (10.2%) or intrauterine growth retardation (5.1%). Discussion These preliminary data of a real-world patient collectivedemonstrate that a significant number of patients experienced adverse pregnancy outcomes which was associated with a trend towards increased cardiac biomarkers throughout pregnancy and postpartum. As recent studies have shown, interpretation of standard parameters such as cardiac biomarkers is not fully understood during pregnancy, especially in women with pre-existing cardiovascular disease. Our data may aid to understand prognostic implications of cardiac biomarkers during pregnancy.

中文翻译：

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心脏产科登记处短期结局的初步数据


背景 怀孕会导致心血管系统内的生理变化，例如血浆容量和心输出量增加或高凝状态。对于患有心血管疾病且并发症风险较高的女性来说，这些变化可能具有挑战性。欧洲心脏病学会 （European Society of Cardiology） 的指南建议，由跨学科妊娠心脏团队在专科中心治疗高危患者。本校医院以团队为基础的方式成立了妊娠心脏团队，以建立特定的沟通和责任结构。方法 建立了 2022 年 11 月至 2024 年 3 月期间妊娠心脏团队治疗的所有患者的前瞻性登记。患者包括怀孕期间已有心血管疾病的妇女以及发生妊娠相关心血管疾病的妇女。在整个妊娠期间，通过实验室工作和超声心动图在每个孕期以及产后对患者进行评估。结果 共有 39 名女性 （平均年龄 34±5 岁） 被前瞻性纳入登记。17 例患者 （43.5%） 被归类为 mWHO ≥ III。17 例 （43.5%） 患有预先存在的 （妊娠相关） 心血管疾病的患者在整个妊娠和分娩过程中接受了管理。9 例患者 （18.4%） 发生妊娠相关心血管疾病，例如围产期心肌病或自发性冠状动脉夹层。初步数据显示，平均左心室射血分数在怀孕期间保持稳定，产后有降低值的趋势不显著。 高敏肌钙蛋白 T 和 NT-pro-BNP 等心脏生物标志物在妊娠晚期和产后呈无统计学意义的升高趋势。14 例患者 （35.9%） 发生不良孕产妇结局，包括胎膜早破 （12.2%） 、妊娠高血压 （7.6%）、妊娠糖尿病 （5.1%）、子痫前期/子痫 （7.6%） 和分娩相关并发症 （10.2%）。胎儿并发症包括巨大儿 （10.2%） 或宫内生长迟缓 （5.1%）。讨论这些真实世界患者集体的初步数据表明，大量患者经历了不良妊娠结局，这与整个怀孕和产后心脏生物标志物增加的趋势有关。正如最近的研究表明，在怀孕期间，对心脏生物标志物等标准参数的解释尚不完全清楚，尤其是在患有心血管疾病的女性中。我们的数据可能有助于了解怀孕期间心脏生物标志物的预后影响。