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. 2026 Feb 25;5(3):102605.
doi: 10.1016/j.jacadv.2026.102605. Online ahead of print.

Pregnancy in Women With Impaired Left Ventricular Function: Data From ROPAC

Puck N J Peters  1 , Sahra Ünlütürk  1 , Avraham Shotan  2 , Lucia Baris  1 , Laura Galian Gay  3 , Niloufar Samiei  4 , Mark R Johnson  5 , Helmut Baumgartner  6 , Mette-Elise Estensen  7 , Olga Irtyuga  8 , Francesca M Comoglio  9 , Waltraut M Merz  10 , Roger Hall  11 , Jolien W Roos-Hesselink  12 ; ROPAC Investigators Group
Collaborators, Affiliations

Pregnancy in Women With Impaired Left Ventricular Function: Data From ROPAC

Puck N J Peters et al. JACC Adv. .

Abstract

Background: The hemodynamic changes during pregnancy can be challenging in women with underlying heart disease, particularly in women with impaired left ventricular function (LVF, left ventricular ejection fraction <40%).

Objectives: The aim of this study was to describe the cardiac, obstetric, and fetal outcomes of pregnancy in women with impaired LVF.

Methods: ROPAC (Registry Of Pregnancy and Cardiac disease) includes an international, prospective, observational cohort of pregnancies in women with heart disease. Cardiac, obstetric, and fetal outcomes were analyzed in 251 patients with impaired LVF. The primary endpoint was the occurrence of major adverse cardiac events (MACE) including maternal death, supraventricular or ventricular arrhythmias, heart failure, aortic dissection, endocarditis, ischemic coronary event, and other thromboembolic events. Logistic regression was used to determine variables associated with poor outcomes.

Results: Median follow-up duration was 7 (6-11) months. Maternal mortality occurred in 6/251 (2.4%, 1%-5%) and heart failure in 67/251 (27%, 21%-33%) patients. Ventricular tachyarrhythmias occurred in 11/251 (4%, 2%-8%) patients. Eighty-one of 251 (32%, 27%-38%) patients experienced at least one MACE during pregnancy or up to 6 months postpartum. Obstetric complications were common, including preterm birth in 67/251 (27%, 22%-33%) and low birthweight in 65/251 (26%, 21%-32%). Patients with cardiomyopathy were at higher risk of cardiovascular complications with 4.3% mortality and nearly 40% risk of MACE during pregnancy. Prepregnancy signs of heart failure (OR: 2.67; 1.3-5.6), atrial fibrillation (OR: 6.32; 3.0-13.3), and an NYHA functional class >II (OR: 6.06; 2.2-16.6) were associated with poor cardiac outcomes.

Conclusions: Women with impaired LVF are at increased risk of complications, particularly heart failure, tachyarrhythmias, and premature delivery with low birth weight.

Keywords: cardiomyopathy; heart disease; heart failure; maternal mortality; pregnancy.

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Conflict of interest statement

Funding support and author disclosures Funding from “Zabawas Foundation” and “De Hoop Foundation” in addition to the support from EORP is greatly acknowledged. Since the start of EORP, the following companies have supported the program: Abbott Vascular Int (2011-2021), Amgen Cardiovascular (2009-2018), AstraZeneca (2014-2021), Bayer AG (2009-2018), Boehringer Ingelheim (2009-2019), Boston Scientific (2009-2012), The Bristol Myers Squibb and Pfizer Alliance (2011-2019), Daiichi Sankyo Europe GmbH (2011-2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014-2017), Edwards (2016-2019), Gedeon Richter Plc. (2014-2016), Menarini Int. Op. (2009-2012), MSD-Merck & Co (2011-2014), Novartis Pharma AG (2014-2020), ResMed (2014-2016), Sanofi (2009-2011), and SERVIER (2009-2021). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Overview of Prospective Cohort Study on Pregnant Women With Impaired Left Ventricular Function From ROPAC I-II MACE = major adverse cardiac events; ROPAC = Registry of Pregnancy and Cardiac disease.
Figure 1
Figure 1
Diagnosis Details of 251 Pregnant Women With Impaired Left Ventricular Function
Figure 2
Figure 2
Associations With MACE in Women With Impaired LVF MACE = major adverse cardiac event; other abbreviation as in Figure 1.
See this image and copyright information in PMC

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