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Publications

Journal Article Ahead of print

PubMed: 41747706 DOI: 10.1016/j.jacadv.2026.102605

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

JACC Adv 5(3):102605

Authors: Puck N J Peters, Sahra Ünlütürk, Avraham Shotan, Lucia Baris, Laura Galian Gay, Niloufar Samiei, Mark R Johnson, Helmut Baumgartner, Mette-Elise Estensen, Olga Irtyuga, Francesca M Comoglio, Waltraut M Merz, Roger Hall, Jolien W Roos-Hesselink

Affiliations

  • Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
  • Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.
  • Department of Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.
  • Rajaei Cardiovascular Medical and Research Center, Tehran, Iran.
  • Department of Obstetric Medicine, Imperial College London, London, United Kingdom.
  • Department of Cardiology, University Hospital Muenster, Muenster, Germany.
  • Department of Cardiology, Oslo University Hospital, Oslo, Norway.
  • Department of Cardiology, Almazov Federal Medical Research Centre, Saint Petersburg, Russia.
  • Department of Surgical Sciences, University of Torino, Torino, Italy.
  • Department of Obstetric Medicine, University Hospital of Bonn, Bonn, Germany.
  • Department of Cardiology, University of East Anglia, Norwich, United Kingdom.
  • Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.

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.

MeSH

Pregnancy, Mortality, Heart Diseases, Ventricular Function, Left, Parturition, Heart Failure, Heart, Birth Weight, Maternal Mortality, Ventricular Function, Cardiomyopathies