Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot

Objective Patients with tetralogy of Fallot (TOF) have high survival rates 30 years after surgical repair. Many patients experience pregnancy; however, the effects of pregnancy on the long-term cardiovascular outcome are not well known. We investigated the association of pregnancy and cardiac functi...

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Autores principales:	Mette E Estensen, Helge Skulstad, Thor Edvardsen, Oyvind H Lie, Kristina Haugaa, Alessia Quattrone, Eirik Nestaas, Charlotte de Lange, Kirsti Try, Harald L Lindberg
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/5c9af9140acb4f5e80881e361ac33ccb
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spelling	oai:doaj.org-article:5c9af9140acb4f5e80881e361ac33ccb2021-11-25T03:00:05ZImpact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot10.1136/openhrt-2020-0014002053-3624https://doaj.org/article/5c9af9140acb4f5e80881e361ac33ccb2021-06-01T00:00:00Zhttps://openheart.bmj.com/content/8/1/e001400.fullhttps://doaj.org/toc/2053-3624Objective Patients with tetralogy of Fallot (TOF) have high survival rates 30 years after surgical repair. Many patients experience pregnancy; however, the effects of pregnancy on the long-term cardiovascular outcome are not well known. We investigated the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women with TOF.Methods We recruited 80 women with repaired TOF from the national database. Holter monitoring or implanted devices detected VA, defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. All patients underwent echocardiography. Blood tests included NT-proBNP (N-terminal pro-brain natriuretic peptide).Results 55 (69%) women had experienced pregnancy. Mean age was lower in nulliparous compared with those with children (30±9 vs 40±9, p<0.01).VA had occurred in 17 (21%) women. Prevalence of VA was higher in women who had experienced pregnancy (n=16, 94%) compared with nulliparous (n=1, 6%) (p=0.02), also when adjusted for age (OR 12.9 (95% CI 1.5 to 113.2), p=0.02).Right ventricular mechanical dispersion was more pronounced in patients with VA (50±8 ms vs 39±14 ms, p=0.01, age-adjusted OR 2.1 (95% CI 1.3 to 7.5), p=0.01). NT-proBNP was also a marker of VA (211 ng/L (127 to 836) vs 139 ng/L (30 to 465), p=0.007). NT-proBNP >321 ng/L (normal values <170 ng/L) detected women with VA (p=0.019), also independent of age (OR 7.2 (95% CI 1.7 to 30.1), p=0.007).Conclusion Pregnancy was associated with higher prevalence of VA among women with TOF. Right ventricular mechanical dispersion and NT-proBNP were age-independent markers of VA. These may have importance for pregnancy counselling and risk stratification.Mette E EstensenHelge SkulstadThor EdvardsenOyvind H LieKristina HaugaaAlessia QuattroneEirik NestaasCharlotte de LangeKirsti TryHarald L LindbergBMJ Publishing GrouparticleDiseases of the circulatory (Cardiovascular) systemRC666-701ENOpen Heart, Vol 8, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Diseases of the circulatory (Cardiovascular) system RC666-701 Mette E Estensen Helge Skulstad Thor Edvardsen Oyvind H Lie Kristina Haugaa Alessia Quattrone Eirik Nestaas Charlotte de Lange Kirsti Try Harald L Lindberg Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot
description	Objective Patients with tetralogy of Fallot (TOF) have high survival rates 30 years after surgical repair. Many patients experience pregnancy; however, the effects of pregnancy on the long-term cardiovascular outcome are not well known. We investigated the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women with TOF.Methods We recruited 80 women with repaired TOF from the national database. Holter monitoring or implanted devices detected VA, defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. All patients underwent echocardiography. Blood tests included NT-proBNP (N-terminal pro-brain natriuretic peptide).Results 55 (69%) women had experienced pregnancy. Mean age was lower in nulliparous compared with those with children (30±9 vs 40±9, p<0.01).VA had occurred in 17 (21%) women. Prevalence of VA was higher in women who had experienced pregnancy (n=16, 94%) compared with nulliparous (n=1, 6%) (p=0.02), also when adjusted for age (OR 12.9 (95% CI 1.5 to 113.2), p=0.02).Right ventricular mechanical dispersion was more pronounced in patients with VA (50±8 ms vs 39±14 ms, p=0.01, age-adjusted OR 2.1 (95% CI 1.3 to 7.5), p=0.01). NT-proBNP was also a marker of VA (211 ng/L (127 to 836) vs 139 ng/L (30 to 465), p=0.007). NT-proBNP >321 ng/L (normal values <170 ng/L) detected women with VA (p=0.019), also independent of age (OR 7.2 (95% CI 1.7 to 30.1), p=0.007).Conclusion Pregnancy was associated with higher prevalence of VA among women with TOF. Right ventricular mechanical dispersion and NT-proBNP were age-independent markers of VA. These may have importance for pregnancy counselling and risk stratification.
format	article
author	Mette E Estensen Helge Skulstad Thor Edvardsen Oyvind H Lie Kristina Haugaa Alessia Quattrone Eirik Nestaas Charlotte de Lange Kirsti Try Harald L Lindberg
author_facet	Mette E Estensen Helge Skulstad Thor Edvardsen Oyvind H Lie Kristina Haugaa Alessia Quattrone Eirik Nestaas Charlotte de Lange Kirsti Try Harald L Lindberg
author_sort	Mette E Estensen
title	Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot
title_short	Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot
title_full	Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot
title_fullStr	Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot
title_full_unstemmed	Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot
title_sort	impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of fallot
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/5c9af9140acb4f5e80881e361ac33ccb
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Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot

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