title: Cardiovascular magnetic resonance imaging predictors of pregnancy outcomes in women with coarctation of the aorta.
abstract: OBJECTIVE
  The aim of this study was to determine associations between aortic morphometry evaluated by cardiovascular magnetic resonance (CMR) and pregnancy outcomes in women with aortic coarctation (CoA).
  
  
  METHODS
  Consecutive women with CoA seen with CMR within 2 years of delivery were reviewed. Aortic dimensions were measured on CMR angiography. Adverse outcomes (cardiovascular, obstetric, and foetal/neonatal) were documented.
  
  
  RESULTS
  We identified 28 women (4 with native and 24 with repaired CoA) who had 30 pregnancies. There were 29 live births (1 stillbirth) at mean gestation 38 ± 2 weeks. Mean maternal ages at first cardiac intervention and pregnancy were 6 ± 8 and 29 ± 6 years, respectively. There were nine cardiovascular events (hypertensive complications in five; stroke in two and arrhythmia in two) occurring in seven pregnancies. Minimum aortic dimensions were smaller in women with cardiovascular events (12.1 vs. 14.3 mm, P = 0.001), specifically in those with hypertensive complications (11.6 vs. 14.4 mm, P < 0.001). From receiver operator curve analysis, optimal discrimination for the development of adverse cardiovascular events occurred at the 12 mm diameter threshold [sensitivity 78%, specificity 91%, area under the curve 0.86 (95% CI: 0.685-1)]. All hypertensive events occurred in conjunction with a minimum aortic diameter of 12 mm (7mm/m(2)) or less. No adverse outcomes occurred if minimum diameter exceeded 15 mm.
  
  
  CONCLUSIONS
  Smaller aortic dimensions relate to increased risk of hypertensive events in pregnant women with CoA. CMR can aid in stratification of risk for women with CoA who are considering pregnancy.
authors.affiliation: Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Jimenez-Juan
authors.forename: Eric V
authors.initials: EV
authors.lastname: Krieger
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Valente
authors.forename: Tal
authors.initials: T
authors.lastname: Geva
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Wintersperger
authors.forename: Hadas
authors.initials: H
authors.lastname: Moshonov
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Siu
authors.forename: Jack M
authors.initials: JM
authors.lastname: Colman
authors.forename: Candice K
authors.initials: CK
authors.lastname: Silversides
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Wald
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001017:Aortic Coarctation / Q000175:diagnosis* / Q000601:surgery; D015331:Cohort Studies; D003287:Contrast Media; D005260:Female; D005865:Gestational Age; D006801:Humans; D021621:Imaging, Three-Dimensional; D016015:Logistic Models; D018810:Magnetic Resonance Angiography / Q000379:methods*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis*; D011256:Pregnancy Outcome; D012372:ROC Curve; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Aortic coarctation; Cardiovascular magnetic resonance; Pregnancy