title: Heart failure in pregnant women with cardiac disease: data from the ROPAC.
abstract: OBJECTIVE
  Heart failure (HF) is one of the most important complications in pregnant women with heart disease, causing maternal and fetal mortality and morbidity.
  
  
  METHODS
  This is an international observational registry of patients with structural heart disease during pregnancy. Sixty hospitals in 28 countries enrolled 1321 women between 2007 and 2011. Pregnant women with valvular heart disease, congenital heart disease, ischaemic heart disease, or cardiomyopathy could be included. Main outcome measures were onset and predictors of HF and maternal and fetal death.
  
  
  RESULTS
  In total, 173 (13.1%) of the 1321 patients developed HF, making HF the most common major cardiovascular complication during pregnancy. Baseline parameters associated with HF were New York Heart Association class ≥ 3, signs of HF, WHO category ≥ 3, cardiomyopathy or pulmonary hypertension. HF occurred at a median time of 31 weeks gestation (IQR 23-40) with the highest incidence at the end of the second trimester (34%) or peripartum (31%). Maternal mortality was higher in patients with HF (4.8% in patients with HF and 0.5% in those without HF p<0.001). Pre-eclampsia was strongly related to HF (OR 7.1, 95% CI 3.9 to 13.2, p<0.001). Fetal death and the incidence of preterm birth were higher in women with HF compared to women without HF (4.6% vs 1.2%, p=0.001; and 30% vs 13%, p=0.001).
  
  
  CONCLUSIONS
  HF was the most common complication during pregnancy, and occurred typically at the end of the second trimester, or after birth. It was most common in women with cardiomyopathy or pulmonary hypertension and was strongly associated with pre-eclampsia and an adverse maternal and perinatal outcome.
authors.affiliation: Erasmus Medical Center, , Rotterdam, The Netherlands.
authors.forename: Titia P E
authors.initials: TP
authors.lastname: Ruys
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.forename: Roger
authors.initials: R
authors.lastname: Hall
authors.forename: Maria T
authors.initials: MT
authors.lastname: Subirana-Domènech
authors.forename: Jennifer
authors.initials: J
authors.lastname: Grando-Ting
authors.forename: Mette
authors.initials: M
authors.lastname: Estensen
authors.forename: Roberto
authors.initials: R
authors.lastname: Crepaz
authors.forename: Vlasta
authors.initials: V
authors.lastname: Fesslova
authors.forename: Michelle
authors.initials: M
authors.lastname: Gurvitz
authors.forename: Julie
authors.initials: J
authors.lastname: De Backer
authors.forename: Mark R
authors.initials: MR
authors.lastname: Johnson
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
mesh_terms: D000328:Adult; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D046689:Fetal Mortality; D006333:Heart Failure / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008428:Maternal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: CONGENITAL HEART DISEASE; HEART FAILURE; MYOCARDIAL DISEASE; VALVULAR DISEASE