Utility of Exercise Stress Echocardiography for Prepregnancy Risk Stratification in Women With Left Heart Obstruction

Left heart obstruction is a high maternal cardiovascular (CV) risk state with severe obstruction classified as modified World Health Organization risk III-IV (mWHO ≥ 3), depending on symptomatic status, associated with a minimum cardiac event rate of 1 in 5. 1 Regitz-Zagrosek V. Roos-Hesselink J.W. Bauersachs J. et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018; 39: 3165-3241 Crossref PubMed Scopus (1222) Google Scholar Guidelines recommend expert preconception counselling, with care during pregnancy provided in an expert centre for pregnancy and cardiac disease. A variety of risk stratification tools (CARPREG II [Cardiac Disease in Pregnancy II], ZAHARA [Zwangerschap bij Aangeboren Hartafijkingen (Pregnancy With Congenital Heart Disease)]) have been proposed to inform shared decision-making. 2 Silversides C.K. Grewal J. Mason J. et al. Pregnancy outcomes in women with heart disease: the CARPREG II study. J Am Coll Cardiol. 2018; 71: 2419-2430 Crossref PubMed Scopus (314) Google Scholar ,3 Yap S.C. Drenthen W. Pieper P.G. et al. Risk of complications during pregnancy in women with congenital aortic stenosis. Int J Cardiol. 2008; 126: 240-246 Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar Although exercise stress echocardiography (ESE) is recommended in the general management of patients with aortic valve (AV) disease and hypertrophic cardiomyopathy, only the exercise tolerance test (ETT) is required according to consensus pregnancy guidelines. 1 Regitz-Zagrosek V. Roos-Hesselink J.W. Bauersachs J. et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018; 39: 3165-3241 Crossref PubMed Scopus (1222) Google Scholar ,4 Lancellotti P. Pellikka P.A. Budts W. et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2016; 17: 1191-1229 Crossref PubMed Scopus (263) Google Scholar This study was designed to determine: (1) the additional value of ESE beyond ETT for the prediction of adverse events in patients with left heart obstruction; and (2) whether ESE influences downstream clinical decision-making before and during pregnancy. Stress Echocardiography for Prepregnancy Counselling… Ready for Prime Time?Canadian Journal of CardiologyPreviewCardiologists who treat young individuals with moderate or severe forms of structural heart disease often face the challenge of deciding appropriate type and timing for interventions. The age at first surgery, the expected life of a valvular prosthesis or graft, and the surgical risk of each sternotomy can significantly impact a patient’s life expectancy and must be considered at the time of shared decision-making. As if it were not complicated enough, female patients must also weigh in family planning and the risks that might come with a pregnancy, making this an even more challenging decision. Full-Text PDF