Cardiovascular magnetic resonance imaging predictors of pregnancy outcomes in women with coarctation of the aorta.

Abstract

AIMS:

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.

CONCLUSION:

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: Laura Jimenez-Juan, Eric V Krieger, Anne Marie Valente, Tal Geva, Bernd J Wintersperger, Hadas Moshonov, Samuel C Siu, Jack M Colman, Candice K Silversides, Rachel M Wald
• Journal: European heart journal. Cardiovascular Imaging (Eur Heart J Cardiovasc Imaging) Vol. 15 Issue 3 Pg. 299-306 (Mar 2014) ISSN: 2047-2412 [Electronic] England
• PMID: 24037808 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Contrast Media

Topics

• Adult
• Analysis of Variance
• Aortic Coarctation (diagnosis, surgery)
• Cohort Studies
• Contrast Media
• Female
• Gestational Age
• Humans
• Imaging, Three-Dimensional
• Logistic Models
• Magnetic Resonance Angiography (methods)
• Predictive Value of Tests
• Pregnancy
• Pregnancy Complications, Cardiovascular (diagnosis)
• Pregnancy Outcome
• ROC Curve
• Retrospective Studies
• Statistics, Nonparametric
• Young Adult