Document Detail

Heart rate response during exercise and pregnancy outcome in women with congenital heart disease.
MedLine Citation:
PMID:  21220738     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cardiopulmonary exercise testing is often used to evaluate exercise capacity in adults with congenital heart disease including women who are considering pregnancy. The relationship between cardiopulmonary exercise testing parameters and pregnancy outcome has not been defined.
METHODS AND RESULTS: We conducted a multicenter retrospective observational study of women with congenital heart disease who had undergone cardiopulmonary exercise testing within 2 years of pregnancy or during the first trimester. Cardiopulmonary exercise testing variables included peak oxygen consumption and measures of chronotropic response: peak heart rate, percentage of maximum age predicted heart rate, heart rate reserve (peak heart rate-resting heart rate), and chronotropic index [(peak heart rate-resting heart rate)/(220-age-resting heart rate)]. We identified 89 pregnancies in 83 women. There were 4 spontaneous abortions and 1 termination. One or more adverse cardiac events occurred in 18%; congestive heart failure in 14%, and sustained arrhythmia in 7%. Peak heart rate (odds ratio [OR] 0.71; 95% confidence interval [CI] [0.53, 0.94]; P=0.02), percentage of maximum age predicted heart rate (OR 0.93; 95% CI [0.88, 0.98]; P=0.01), and chronotropic index (OR 0.65; 95% CI [0.47, 0.90]; P=0.01) were associated with a cardiac event. Neonatal events occurred in 20%. Peak heart rate (OR 0.75; 95% CI [0.58, 0.98]; P=0.04), percentage of maximum age predicted heart rate (OR 0.94; 95% CI [0.89, 0.99]; P=0.02), heart rate reserve (OR 0.8; 95% CI [0.64, 0.99]; P=0.04), and chronotropic index (OR 0.73; 95% CI [0.54, 0.98]; P=0.04) correlated with a neonatal event. Peak oxygen consumption was not associated with an adverse pregnancy outcome.
CONCLUSIONS: Abnormal chronotropic response correlates with adverse pregnancy outcomes in women with congenital heart disease and should be considered in refining risk stratification schemes.
George K Lui; Candice K Silversides; Paul Khairy; Sue M Fernandes; Anne Marie Valente; Michelle J Nickolaus; Michael G Earing; Jamil A Aboulhosn; Marlon S Rosenbaum; Stephen Cook; Joseph D Kay; Zhezhen Jin; Deborah R Gersony;
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2011-01-10
Journal Detail:
Title:  Circulation     Volume:  123     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-25     Completed Date:  2011-03-07     Revised Date:  2011-08-19    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  242-8     Citation Subset:  AIM; IM    
Montefiore Medical Center, Bronx, NY 10467, USA.
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MeSH Terms
Exercise / physiology*
Exercise Test
Heart Defects, Congenital / epidemiology,  physiopathology*
Heart Rate / physiology*
Oxygen Consumption / physiology
Predictive Value of Tests
Pregnancy Complications, Cardiovascular / epidemiology,  physiopathology*
Pregnancy Outcome* / epidemiology
Retrospective Studies
Risk Factors
Young Adult
Comment In:
Curr Cardiol Rep. 2011 Aug;13(4):269-70   [PMID:  21484600 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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