Global cardiac risk assessment in the Registry Of Pregnancy And Cardiac disease: results of a registry from the European Society of Cardiology.

AIMS: To validate the modified World Health Organization (mWHO) risk classification in advanced and emerging countries, and to identify additional risk factors for cardiac events during pregnancy. METHODS AND RESULTS: The ongoing prospective worldwide Registry Of Pregnancy And Cardiac disease (ROPAC) included 2742 pregnant women (mean age ± standard deviation, 29.2 ± 5.5 years) with established cardiac disease: 1827 from advanced countries and 915 from emerging countries. In patients from advanced countries, congenital heart disease was the most prevalent diagnosis (70%) while in emerging countries valvular heart disease was more common (55%). A cardiac event occurred in 566 patients (20.6%) during pregnancy: 234 (12.8%) in advanced countries and 332 (36.3%) in emerging countries. The mWHO classification had a moderate performance to discriminate between women with and without cardiac events (c-statistic 0.711 and 95% confidence interval (CI) 0.686-0.735). However, its performance in advanced countries (0.726) was better than in emerging countries (0.633). The best performance was found in patients with acquired heart disease from developed countries (0.712). Pre-pregnancy signs of heart failure and, in advanced countries, atrial fibrillation and no previous cardiac intervention added prognostic value to the mWHO classification, with a c-statistic of 0.751 (95% CI 0.715-0.786) in advanced countries and of 0.724 (95% CI 0.691-0.758) in emerging countries. CONCLUSION: The mWHO risk classification is a useful tool for predicting cardiac events during pregnancy in women with established cardiac disease in advanced countries, but seems less effective in emerging countries. Data on pre-pregnancy cardiac condition including signs of heart failure and atrial fibrillation, may help to improve preconception counselling in advanced and emerging countries.

[Echocardiographic assessment of left atrial volume in asymptomatic ambulatory patients with metabolic syndrome and/or arterial hypertension - is it parameter worth into considerate?]. / Echokardiograficzna ocena objetosci lewego przedsionka u pacjentów bezobjawowych z nadcisnieniem tetniczym i/lub z zespolem metabolicznym w opiece ambulatoryjnej - czy warto oceniac ten parametr?

INTRODUCTION: Early identification of high-risk patients, including those with arterial hypertension (AH) andlor metabolic syndrome (MS), have a positive effect on the treatment and the cost. Left atrial volume is a well-known, easy to examine prognostic factor in cardiovascular diseases. Impaired function and enlargement of the left atrium could be present in even when asymptomatic patients with AH, but in subjects with MS has not been well documented. OBJECTIVE: The aim of the study was to estimate the left atrial volume index (LAVI) among asymptomatic patients with AH and/or MS. PATIENTS AND METHODS: One hundred and fourteen consecutive patients were divided into three groups as follows: 54 patients with MS, 34 with AH and 26 in a control group; next they were underwent the echocardiographic examination. A statistical analysis of LAVI was carried out using the Whitney-Mann test. RESULTS: The mean LAVI was: 25.20 ml/m2 for the AH group (woman 24.90 ml/m2; men 25.49 ml/m2); 24.90 ml/m2 for the MS (woman 25.78 ml/m2; men 23.63 ml/m2) and 19.20 ml/m2 for the control group (woman 21.77 ml/m2; men 17.97 ml/m2). There was a positive correlation between increased LAVI and AH or/and MS presence. CONCLUSIONS: The results suggest that left atrial volume index enlargement is more common among even asymptomatic patients suffering from hypertension andlor metabolic syndrome. The estimation of LAVI is possible in a routine echocardiographic examination and seems to be an additional useful parameter in description of risk in cardiovascular diseases.

Clinical and echocardiographic assessment of pregnant women with valvular heart diseases--maternal and fetal outcome.

UNLABELLED: The study aimed to compare the outcome of pregnancy in women with valvular heart diseases. MATERIAL: Two hundred and fifty-nine pregnant women with cardiac diseases, aged 18-42, were observed. Group I-158 patients with mitral valve disease: 30 patients with mitral stenosis; 44 patients with mitral regurgitation, 33 patients with combined mitral valve disease, 51 patients with mitral valve prolapse; Group II-54 patients with aortic valve disease: 32 patients with aortic stenosis, 22 with aortic regurgitation; Group III-47 patients after valve replacement (36 mechanical; 11 homograft valves). Medical history and physical examination, NYHA class assessment, ECG, and echocardiography were performed during consecutive trimesters of pregnancy and after delivery. RESULTS: Clinical deterioration was observed in 38 patients-in 25 women of Group I, 6 women of Group II, and 7 women of Group III. Newborns outcome : 250 healthy (10 prematures, 12 with intrauterine growth retardation), 6 aborted, 2 stillbirths, 1 neonatal death. Method of delivery : 200 vaginally, 53 cesarean sections. CONCLUSIONS: (1). Pregnants with critical mitral valve stenosis form a high-risk group of life-threatening complications. (2) In women with severe aortic stenosis, pregnancy could lead to sudden clinical status deterioration. (3) Cardiac complications can be expected in patients with left ventricular enlargement and its depressed function. (4) Key factors influencing successful course of pregnancy and labour in patients with prosthetic valves: adequate left ventricular function, properly functioning valves, and effective anticoagulation.

[Comparison of quantitative echocardiographic methods with angiography for assessment of mitral regulation]. / Ilosciowa ocena niedomykalnosci mitralnej--porównanie metody echokardiograficznej i angiograficznej.

UNLABELLED: The aim of this study was to compare echocardiographic assessment of the severity of mitral regurgitation (MR) with angiographic grading. MATERIAL: 51 patients (patients) with MR (43 men and 8 women), aged from 38 to 75 (mean 56 +/- 9 years), were used in the study. The etiology of MR was: Coronary artery disease (28 pts), infective endocarditis (3 patients), rheumatic disease (5 patients), dilated cardiomyopathy (7 patients), mitral valve prolapse (8 patients). EXCLUSION CRITERIA: Aortic stenosis and/or aortic insufficiency, mitral stenosis, mechanical prostheses and atrial fibrillation. METHODS: The mitral regurgitant volume (RV) and effective regurgitant orifice (ERO) were estimated by the proximal convergence method (PISA), regurgitant fraction (RF) and vena contracta width (VCW) by color Doppler quantitative method and compared to the cine ventriculographic grades. The angio-graphic severity of MR was classified as 1 to 4 grades according to the Sellers criteria. RESULTS: There was a good correlation between the angiographic grading and ERO (r = 0.855, p < 0.001), RV (r = 0.868, p < 0.001), RF (r = 0.923, p < 0.001) and VCW (r = 0.846, p < 0.001). CONCLUSIONS: 1. PISA method is clinically useful in routine evaluation of the severity of MR. 2. VCW provides a simple method for the identification of patients with severe MR. 3. These methods offer an alternative approach in quantifying MR noninvasively.