Cardiopulmonary variables during exercise predict pregnancy outcome in women with congenital heart disease.
BACKGROUND
Maternal New York Heart Association (NYHA) class is associated with pregnancy outcome in women with congenital heart disease (WCHD), but objective predictive criteria of exercise capacity have not been established.


RESULTS
A total of 33 WCHD (age, 28 ± 5 years; NYHA class, 1.3 ± 0.6) who had undergone cardiopulmonary exercise testing (CPX) 1.8 ± 2.2 years before their delivery were retrospectively identified. Maternal, cardiac, and neonatal events occurred in 8 (24%), 12 (36%), and 14 (42%), respectively. All CPX parameters correlated with neonatal birth weight (P<0.05-0.001). Exercise time, peak heart rate (HR), peak systolic blood pressure, and peak oxygen uptake (VO(2)) were associated with cardiac events (P<0.05-0.01), and exercise time and peak VO(2) were also associated with neonatal events (P<0.05). Exercise time, peak HR, and peak VO(2) were associated with at least 1 of the 3 events (P<0.05-0.01). Receiver operating characteristic analysis showed that peak HR <150 beats/min and/or peak VO(2) <22.0 ml · kg(-1) · min(-1), peak VO(2) <26.2 ml · kg(-1) · min(-1), and peak HR <150 beats/min and/or peak VO(2) <25.3 ml · kg(-1) · min(-1) predicted a high probability of maternal cardiac, neonatal, and maternal cardiac and/or neonatal event, respectively.


CONCLUSIONS
CPX parameters predict pregnancy outcome and peak HR ≥ 150 beats/min and/or peak VO(2) ≥ 25 ml · kg(-1) · min(-1) may be reference value(s) for a safer pregnancy outcome in WCHD.
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita 565-8565, Japan. hohuchi@hsp.ncvc.go.jp
Hideo
H
Ohuchi
Yuka
Y
Tanabe
Chizuko
C
Kamiya
Kanae
K
Noritake
Kenji
K
Yasuda
Aya
A
Miyazaki
Tomoaki
T
Ikeda
Osamu
O
Yamada
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology; D001724:Birth Weight / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D010101:Oxygen Consumption / Q000502:physiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D011256:Pregnancy Outcome / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult