המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-30 16:00:34 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) – An index that rates cardiovascular risk factors in pregnant women who have heart disease can accurately estimate the risk of cardiac events during pregnancy.
To develop their index, Dr. Samuel C. Siu from Toronto General Hospital and colleagues prospectively followed 546 pregnant women with heart disease who completed 599 pregnancies, according to their report in the July 31st issue of Circulation: Journal of the American Heart Association.
There were primary cardiac events in 80 completed pregnancies, with 55% occurring prepartum. In all but three episodes, pulmonary edema occurred.
The researchers identified four primary predictors of cardiac events among these women. These included a prior cardiac event or arrhythmia; New York Heart Association class II or greater or cyanosis at baseline; left heart obstruction or peak left ventricular outflow gradient; and reduced systemic ventricular systolic function.
Dr. Siu's group assigned each risk factor one point. For women with no points, the estimated risk of a cardiac event during pregnancy was 5%, for women with 1 point, the estimated risk was 27%; and for those with more than 1 point, the risk of a cardiac event during pregnancy was 75%.
Using this index, "there was excellent agreement between the expected and observed rate of events." The researchers point out that of the three cardiac deaths in the cohort, all three women had risk scores of 1 or greater.
Based on these findings, Dr. Siu and colleagues believe cardiac intervention should be considered before conception for women at high risk. Women whose risk is high or moderate (a score of 1 or greater) "should be referred to a regional center for ongoing care," while women with scores of 0 "can safely deliver in a community hospital."
Dr. Siu told Reuters Health that their findings also demonstrate that most women with heart disease have a low risk index and do well during pregnancy.
"Recommendations to avoid pregnancy are sometimes made based on the presence of any sort of maternal heart condition." Dr. Sui hopes these data and the risk index described in their paper will provide a basis for avoiding unwarranted advice, as well as unnecessary investigation and treatment of women at low risk.
Circulation 2001;104:000-000. http://www.circulationaha.org.
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