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. 2024 Dec 31;14(6):1058-1069.
doi: 10.21037/cdt-24-248. Epub 2024 Dec 19.

Pregnancy & cardiovascular disease: the PREG-CVD-HH registry

Dora Csengeri #  1   2 , Elisabeth Unger #  1   2 , Jessica Weimann  1 , Michael Huntgeburth  3   4 , Yskert von Kodolitsch  5 , Tanja Zeller  1   2 , Stefan Blankenberg  1   2   6 , Paulus Kirchhof  1   2 , Anke Diemert  7 , Renate B Schnabel  1   2 , Christoph R Sinning  1   2 , Elvin Zengin-Sahm  1   2
Affiliations

Pregnancy & cardiovascular disease: the PREG-CVD-HH registry

Dora Csengeri et al. Cardiovasc Diagn Ther. .

Abstract

Background: Cardiovascular disease (CVD) remains the leading cause of death in pregnant and peripartal women in western countries. Physiological changes during pregnancy can lead to cardiovascular complications in the mother; women with pre-existing heart disease may not tolerate these changes well, increasing their susceptibility to adverse cardiovascular outcomes during pregnancy. The aim of this study is to characterize pregnancy-induced changes in cardiac function, biomarker concentrations and cardiovascular outcomes in women with CVD during pregnancy at a tertiary care hospital in Germany.

Methods: The PREG-CVD-HH study is a prospective single-center observational study of pregnant women with prevalent CVD treated at the University Medical Center Hamburg, Germany and currently includes 63 women with congenital or acquired heart disease and ten women from the general population included as controls. Participants underwent baseline assessment and dedicated comprehensive echocardiography. Biomarkers N-terminal pro B-type natriuretic peptide (NT-proBNP), MR-proadrenomedullin (MRproADM) and high-sensitivity cardiac troponin I (hs-cTnI) were measured serially throughout pregnancy and until 6 and 12 months postpartum. A maternal cardiac event was defined as death due to cardiovascular cause, arrhythmia, heart failure or hospitalization for other cardiac intervention.

Results: Mean maternal age was 34 years. A majority had a congenital heart disease (N=41), 10 patients developed pregnancy-associated CVD (e.g., preeclampsia, peripartum cardiomyopathy) and 12 women had known acquired heart disease (e.g., valvular disease, arrhythmia, cardiomyopathy). New-onset heart failure was observed in 14.1% of patients (N=9). Five patients developed arrhythmia and three patients developed preeclampsia. About 21.2% of patients were hospitalized due to cardiovascular events. Death from any or cardiovascular cause did not occur over the study period. Left and right ventricular global longitudinal strain (LV GLS, RV GLS) showed a transient worsening in the third trimester and peripartum period. NT-proBNP ranges broadened during the pregnancy and tended to progressively decrease postpartum in women with CVD. Hs-cTnI levels tended to trend upwards during pregnancy in patients with CVD, however, the hs-cTnI levels remained consistently low throughout pregnancy.

Conclusions: In our cohort, pregnancy was associated with a transient increase in cardiac biomarkers and worsening of cardiac function during the third trimester and peripartum. These temporal changes reversed at 6-12 months postpartum, potentially due to decreased cardiac load, fluid shifts and hormonal changes. Overall, data on reference ranges in echocardiographic and biomarker measurements in the pregnant cardiac population are limited and require further investigation. Albeit one third of our cohort was deemed at high and highest maternal risk during pregnancy, there was no maternal death. We recommend that women with CVD receive preconceptional counselling and ongoing management by a specialized "Pregnancy Heart Team" to optimize care and, potentially, maternal outcomes.

Keywords: Pregnancy; biomarker; echocardiography.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-24-248/coif). The series “Current Management Aspects in Adult Congenital Heart Disease (ACHD): Part VI” was commissioned by the editorial office without any funding or sponsorship. D.C. received a research grant from Wolfgang Seefried Project funding of the German Heart Foundation e.V. Y.V.K. reports that he is a member of the VASCERN HTAD and Marfan Hilfe Deutschland e.V. T.Z. has received funding from the German Research Foundation, the EU Horizon 2020 programme, the EU ERANet and ERAPreMed Programmes, the German Centre for Cardiovascular Research (DZHK, 81Z0710102) and the German Ministry of Education and Research (BMBF 01ZX1408A) and the German Research Foundation. T.Z. is listed as co-inventor of an international patent on the use of a computing device to estimate the probability of myocardial infarction (International Publication Number WO2022043229A1). T.Z. is a shareholder of the ART.EMIS GmbH Hamburg. S.B. is supported by the Innovative medicine initiative (IMI) under grant No. 116074, the Foundation Leducq under grant No. 16 CVD 03, Siemens, Bayer, Astra Zeneca, Deutsche Gesetzliche Unfallversicherung (DGUV) and Novartis. P.K. has received research support for basic, translational, and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), German Centre for Cardiovascular Research, and from several drug and device companies active in atrial fibrillation; is listed on 2 patents held by the University of Birmingham (Atrial Fibrillation Therapy WO 2015140571 and Markers for Atrial Fibrillation WO 2016012783); and has been partially supported by European Union BigData@Heart (grant agreement EU IMI 116074), AFFECT-AF (grant agreement 847770), and MAESTRIA (grant agreement 965286), British Heart Foundation (PG/17/30/32961 and PG/20/22/35093; AA/18/2/34218), German Centre for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK), and Leducq Foundation. A.D. has received funding by the German Research Foundation (Clinical Research Unit 296: DI2103/2-2) and the Authority for Science, Research and Equality, Hanseatic City of Hamburg, Germany (LFF-FV73). R.B.S. has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme under the grant agreement No. 648131, from the European Union’s Horizon 2020 research and innovation programme under the grant agreement No. 847770 (AFFECT-EU) and German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103 and 81Z0710114); German Ministry of Research and Education (BMBF 01ZX1408A) and ERACoSysMed3 (031L0239). RBS has received lecture fees and advisory board fees from BMS/Pfizer and Bayer outside this work. C.R.S. has received lecture fees from Böhringer Ingelheim and Johnson & Johnson outside this work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
LV GLS and RV GLS at preconception, first/second trimesters, third trimesters/peripartum and 6/12 months postpartum. The red lines highlight the LV GLS cut-off of −18% and RV GLS cut-off of −28% in the general population according to the ESC guideline. LV GLS, left ventricular global longitudinal strain; RV GLS, right ventricular global longitudinal strain; ESC, European Society of Cardiology.
Figure 2
Figure 2
NT-proBNP in pg/mL levels and Hs-cTnI in ng/L at preconception, first/second trimesters, third trimester/peripartum and 6/12 months postpartum. The red lines highlight the cut-off of NT-proBNP of 125 pg/mL and of Hs-cTnI of <2 ng/L in the general population according to the ESC guidelines. Y-axis is shown in log scale. NT-proBNP, N-terminal pro B-type natriuretic peptide; Hs-cTnI, high-sensitivity troponin I; ESC, European Society of Cardiology.
Figure 3
Figure 3
Cardiovascular complications during pregnancy. Cardiovascular complications were defined as hospitalisation due to cardiovascular events, heart failure (any) and/or arrhythmia.
See this image and copyright information in PMC

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