Search

Your search keyword '"Elin Folkesson"' showing total 14 results
Start Over Author "Elin Folkesson"
14 results on '"Elin Folkesson"'

1. A protein signature associated with active tuberculosis identified by plasma profiling and network-based analysis

Author

Zaynab Mousavian, Elin Folkesson, Gabrielle Fröberg, Fariba Foroogh, Margarida Correia-Neves, Judith Bruchfeld, Gunilla Källenius, and Christopher Sundling

Subjects
clinical finding, disease, proteomics, infectious disease, Science
Abstract

Summary: Annually, approximately 10 million people are diagnosed with active tuberculosis (TB), and 1.4 million die of the disease. If left untreated, each person with active TB will infect 10–15 new individuals. The lack of non-sputum-based diagnostic tests leads to delayed diagnoses of active pulmonary TB cases, contributing to continued disease transmission. In this exploratory study, we aimed to identify biomarkers associated with active TB. We assessed the plasma levels of 92 proteins associated with inflammation in individuals with active TB (n = 20), latent TB (n = 14), or healthy controls (n = 10). Using co-expression network analysis, we identified one module of proteins with strong association with active TB. We removed proteins from the module that had low abundance or were associated with non-TB diseases in published transcriptomic datasets, resulting in a 12-protein plasma signature that was highly enriched in individuals with pulmonary and extrapulmonary TB and was further associated with disease severity.

Published
2022
Full Text
View/download PDF

2. High Dimensional Immune Profiling Reveals Different Response Patterns in Active and Latent Tuberculosis Following Stimulation With Mycobacterial Glycolipids

Author

Carolina S. Silva, Christopher Sundling, Elin Folkesson, Gabrielle Fröberg, Claudia Nobrega, João Canto-Gomes, Benedict J. Chambers, Tadepally Lakshmikanth, Petter Brodin, Judith Bruchfeld, Jérôme Nigou, Margarida Correia-Neves, and Gunilla Källenius

Subjects
tuberculosis, mycobacterial glycolipids, active tuberculosis (ATB), latent tuberculosis (LTB), hyporesponsiveness, lipoarabinomannan (LAM), Immunologic diseases. Allergy, RC581-607
Abstract

Upon infection with Mycobacterium tuberculosis (Mtb) the host immune response might clear the bacteria, control its growth leading to latent tuberculosis (LTB), or fail to control its growth resulting in active TB (ATB). There is however no clear understanding of the features underlying a more or less effective response. Mtb glycolipids are abundant in the bacterial cell envelope and modulate the immune response to Mtb, but the patterns of response to glycolipids are still underexplored. To identify the CD45+ leukocyte activation landscape induced by Mtb glycolipids in peripheral blood of ATB and LTB, we performed a detailed assessment of the immune response of PBMCs to the Mtb glycolipids lipoarabinomannan (LAM) and its biosynthetic precursor phosphatidyl-inositol mannoside (PIM), and purified-protein derivate (PPD). At 24 h of stimulation, cell profiling and secretome analysis was done using mass cytometry and high-multiplex immunoassay. PIM induced a diverse cytokine response, mainly affecting antigen-presenting cells to produce both pro-inflammatory and anti-inflammatory cytokines, but not IFN-γ, contrasting with PPD that was a strong inducer of IFN-γ. The effect of PIM on the antigen-presenting cells was partly TLR2-dependent. Expansion of monocyte subsets in response to PIM or LAM was reduced primarily in LTB as compared to healthy controls, suggesting a hyporesponsive/tolerance pattern derived from Mtb infection.

Published
2021
Full Text
View/download PDF

3. SARS‐CoV‐2‐specific humoral and cellular immunity persists through 9 months irrespective of COVID‐19 severity at hospitalisation

Author

John Tyler Sandberg, Renata Varnaitė, Wanda Christ, Puran Chen, Jagadeeswara R Muvva, Kimia T Maleki, Marina García, Majda Dzidic, Elin Folkesson, Magdalena Skagerberg, Gustaf Ahlén, Lars Frelin, Matti Sällberg, Lars I Eriksson, Olav Rooyackers, Anders Sönnerborg, Marcus Buggert, Niklas K Björkström, Soo Aleman, Kristoffer Strålin, Jonas Klingström, Hans‐Gustaf Ljunggren, Kim Blom, Sara Gredmark‐Russ, and The Karolinska COVID‐19 Study Group

Subjects
antibodies, antibody‐secreting cells, circulating T follicular helper cells, COVID‐19, germinal centres, SARS‐CoV‐2, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Objectives Humoral and cellular immunity to SARS‐CoV‐2 following COVID‐19 will likely contribute to protection from reinfection or severe disease. It is therefore important to characterise the initiation and persistence of adaptive immunity to SARS‐CoV‐2 amidst the ongoing pandemic. Methods Here, we conducted a longitudinal study on hospitalised moderate and severe COVID‐19 patients from the acute phase of disease into convalescence at 5 and 9 months post‐symptom onset. Utilising flow cytometry, serological assays as well as B cell and T cell FluoroSpot assays, we assessed the magnitude and specificity of humoral and cellular immune responses during and after human SARS‐CoV‐2 infection. Results During acute COVID‐19, we observed an increase in germinal centre activity, a substantial expansion of antibody‐secreting cells and the generation of SARS‐CoV‐2‐neutralising antibodies. Despite gradually decreasing antibody levels, we show persistent, neutralising antibody titres as well as robust specific memory B cell responses and polyfunctional T cell responses at 5 and 9 months after symptom onset in both moderate and severe COVID‐19 patients. Conclusion Our findings describe the initiation and, importantly, persistence of cellular and humoral SARS‐CoV‐2‐specific immunological memory in hospitalised COVID‐19 patients long after recovery, likely contributing towards protection against reinfection.

Published
2021
Full Text
View/download PDF

4. Relating MR relaxation times of ex vivo meniscus to tissue degeneration through comparison with histopathology

Author

Emma Einarsson, Jonas Svensson, Elin Folkesson, Iida Kestilä, Jon Tjörnstrand, Pernilla Peterson, Mikko A.J. Finnilä, H. Velocity Hughes, Aleksandra Turkiewicz, Simo Saarakkala, and Martin Englund

Subjects
MRI, Relaxation times, Histology, Ex vivo, Meniscus, Osteoarthritis, Diseases of the musculoskeletal system, RC925-935
Abstract

Summary: Background: Quantitative magnetic resonance imaging (MRI), e.g. relaxation parameter mapping, may be sensitive to structural and compositional tissue changes, and could potentially be used to non-invasively detect and monitor early meniscus degeneration related to knee osteoarthritis. Objective: To investigate MR relaxation times as potential biomarkers for meniscus degeneration through comparisons with histopathology. Methods: We measured MR relaxation parameters in the posterior horn of 40 menisci (medial and lateral) at a wide range of degenerative stages. T1, T2 and T2∗ were mapped using standard and ultrashort echo time sequences at 9.4 T and compared to gold standard histology using Pauli's histopathological scoring system, including assessment of surface integrity, collagen organization, cellularity and Safranin-O staining. Results: All three relaxation times increased with total Pauli score (mean difference per score (95% CI) for T2∗: 0.62 (0.37, 0.86), T2: 0.83 (0.53, 1.1) and T1: 24.7 (16.5, 32.8) ms/score). Clear associations were seen with scores of surface integrity (mean difference per score for T2∗: 3.0 (1.8, 4.2), T2: 4.0 (2.5, 5.5) and T1: 116 (75.6, 156) ms/score) and collagen organization (mean difference between highest and lowest score for T2∗: 5.3 (1.6, 8.9), T2: 6.1 (1.7, 11) and T1: 204 (75.9, 332) ms). The results were less clear for the remaining histopathological measures. Conclusions: MR relaxation times T1, T2 and T2∗ of ex vivo human menisci are associated with histologically verified degenerative processes, in particular related to surface integrity and collagen organization. If confirmed in vivo, MR relaxation times may thus be potential biomarkers for meniscus degeneration.

Published
2020
Full Text
View/download PDF

5. Differential protein expression in human knee articular cartilage and medial meniscus using two different proteomic methods: a pilot analysis

Author

Elin Folkesson, Aleksandra Turkiewicz, Martin Englund, and Patrik Önnerfjord

Subjects
Meniscus, Articular cartilage, Proteomics, Knee, Data-independent acquisition, Data-dependent acquisition, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background Proteomics is an emerging field in the study of joint disease. Our two aims with this pilot analysis were to compare healthy human knee articular cartilage with meniscus, two tissues both known to become affected in the osteoarthritic disease process, and to compare two mass spectrometry (MS)-based methods: data-dependent acquisition (DDA) and data-independent acquisition (DIA). Methods Healthy knee articular cartilage taken from the medial tibial condyle and medial meniscus samples taken from the body region were obtained from three adult forensic medicine cases. Proteins were extracted from tissue pieces and prepared for MS analysis. Each sample was subjected to liquid chromatography (LC)-MS/MS analysis using an Orbitrap mass spectrometer, and run in both DDA and DIA mode. Linear mixed effects models were used for statistical analysis. Results A total of 653 proteins were identified in the DDA analysis, of which the majority was present in both tissue types. Only proteins with quantitation information in both tissues (n = 90) were selected for more detailed analysis, of which the majority did not statistically significantly differ in abundance between the two tissue types, in either of the MS analyses. However, 21 proteins were statistically significantly different (p

Published
2018
Full Text
View/download PDF

6. Innate lymphoid cell composition associates with COVID‐19 disease severity

Author

Marina García, Efthymia Kokkinou, Anna Carrasco García, Tiphaine Parrot, Laura M Palma Medina, Kimia T Maleki, Wanda Christ, Renata Varnaitė, Iva Filipovic, Hans‐Gustaf Ljunggren, Niklas K Björkström, Elin Folkesson, Olav Rooyackers, Lars I Eriksson, Anders Sönnerborg, Soo Aleman, Kristoffer Strålin, Sara Gredmark‐Russ, Jonas Klingström, Jenny Mjösberg, and the Karolinska KI/K COVID‐19 Study Group

Subjects
coronavirus, COVID‐19, immune response, innate lymphoid cells, respiratory viral infection, SARS‐CoV‐2, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Objectives The role of innate lymphoid cells (ILCs) in coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is unknown. Understanding the immune response in COVID‐19 could contribute to unravel the pathogenesis and identification of treatment targets. Here, we describe the phenotypic landscape of circulating ILCs in COVID‐19 patients and identified ILC phenotypes correlated to serum biomarkers, clinical markers and laboratory parameters relevant in COVID‐19. Methods Blood samples collected from moderately (n = 11) and severely ill (n = 12) COVID‐19 patients, as well as healthy control donors (n = 16), were analysed with 18‐parameter flow cytometry. Using supervised and unsupervised approaches, we examined the ILC activation status and homing profile. Clinical and laboratory parameters were obtained from all COVID‐19 patients, and serum biomarkers were analysed with multiplex immunoassays. Results Innate lymphoid cells were largely depleted from the circulation of COVID‐19 patients compared with healthy controls. Remaining circulating ILCs revealed decreased frequencies of ILC2 in severe COVID‐19, with a concomitant decrease of ILC precursors (ILCp) in all patients, compared with controls. ILC2 and ILCp showed an activated phenotype with increased CD69 expression, whereas expression levels of the chemokine receptors CXCR3 and CCR4 were significantly altered in ILC2 and ILCp, and ILC1, respectively. The activated ILC profile of COVID‐19 patients was associated with soluble inflammatory markers, while frequencies of ILC subsets were correlated with laboratory parameters that reflect the disease severity. Conclusion This study provides insights into the potential role of ILCs in immune responses against SARS‐CoV‐2, particularly linked to the severity of COVID‐19.

Published
2020
Full Text
View/download PDF

7. Challenges in preparing and implementing a clinical trial at field level in an Ebola emergency: A case study in Guinea, West Africa.

Author

Sara Carazo Perez, Elin Folkesson, Xavier Anglaret, Abdoul-Habib Beavogui, Emmanuel Berbain, Alseny-Modet Camara, Evelyn Depoortere, Annabelle Lefevre, Piet Maes, Kristian Nødtvedt Malme, Jean-Marie Denis Malvy, Sien Ombelet, Geertrui Poelaert, Daouda Sissoko, Alexis Tounkara, Pierre Trbovic, Pascal Piguet, and Annick Antierens

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

During the large Ebola outbreak that affected West Africa in 2014 and 2015, studies were launched to evaluate potential treatments for the disease. A clinical trial to evaluate the effectiveness of the antiviral drug favipiravir was conducted in Guinea. This paper describes the main challenges of the implementation of the trial in the Ebola treatment center of Guéckédou. Following the principles of the Good Clinical Research Practices, we explored the aspects of the community's communication and engagement, ethical conduct, trial protocol compliance, informed consent of participants, ongoing benefit/risk assessment, record keeping, confidentiality of patients and study data, and roles and responsibilities of the actors involved. We concluded that several challenges have to be addressed to successfully implement a clinical trial during an international medical emergency but that the potential for collaboration between research teams and humanitarian organizations needs to be highlighted.

Published
2017
Full Text
View/download PDF

8. Correction: Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea.

Author

Daouda Sissoko, Cedric Laouenan, Elin Folkesson, Abdoul-Bing M'Lebing, Abdoul-Habib Beavogui, Sylvain Baize, Alseny-Modet Camara, Piet Maes, Susan Shepherd, Christine Danel, Sara Carazo, Mamoudou N Conde, Jean-Luc Gala, Géraldine Colin, Hélène Savini, Joseph Akoi Bore, Frederic Le Marcis, Fara Raymond Koundouno, Frédéric Petitjean, Marie-Claire Lamah, Sandra Diederich, Alexis Tounkara, Geertrui Poelart, Emmanuel Berbain, Jean-Michel Dindart, Sophie Duraffour, Annabelle Lefevre, Tamba Leno, Olivier Peyrouset, Léonid Irenge, N'Famara Bangoura, Romain Palich, Julia Hinzmann, Annette Kraus, Thierno Sadou Barry, Sakoba Berette, André Bongono, Mohamed Seto Camara, Valérie Chanfreau Munoz, Lanciné Doumbouya, Souley Harouna, Patient Mumbere Kighoma, Fara Roger Koundouno, Réné Lolamou, Cécé Moriba Loua, Vincent Massala, Kinda Moumouni, Célia Provost, Nenefing Samake, Conde Sekou, Abdoulaye Soumah, Isabelle Arnould, Michel Saa Komano, Lina Gustin, Carlotta Berutto, Diarra Camara, Fodé Saydou Camara, Joliene Colpaert, Léontine Delamou, Lena Jansson, Etienne Kourouma, Maurice Loua, Kristian Malme, Emma Manfrin, André Maomou, Adele Milinouno, Sien Ombelet, Aboubacar Youla Sidiboun, Isabelle Verreckt, Pauline Yombouno, Anne Bocquin, Caroline Carbonnelle, Thierry Carmoi, Pierre Frange, Stéphane Mely, Vinh-Kim Nguyen, Delphine Pannetier, Anne-Marie Taburet, Jean-Marc Treluyer, Jacques Kolie, Raoul Moh, Minerva Cervantes Gonzalez, Eeva Kuisma, Britta Liedigk, Didier Ngabo, Martin Rudolf, Ruth Thom, Romy Kerber, Martin Gabriel, Antonino Di Caro, Roman Wölfel, Jamal Badir, Mostafa Bentahir, Yann Deccache, Catherine Dumont, Jean-François Durant, Karim El Bakkouri, Marie Gasasira Uwamahoro, Benjamin Smits, Nora Toufik, Stéphane Van Cauwenberghe, Khaled Ezzedine, Eric D'Ortenzio, Louis Pizarro, Aurélie Etienne, Jérémie Guedj, Alexandra Fizet, Eric Barte de Sainte Fare, Bernadette Murgue, Tuan Tran-Minh, Christophe Rapp, Pascal Piguet, Marc Poncin, Bertrand Draguez, Thierry Allaford Duverger, Solenne Barbe, Guillaume Baret, Isabelle Defourny, Miles Carroll, Hervé Raoul, Augustin Augier, Serge P Eholie, Yazdan Yazdanpanah, Claire Levy-Marchal, Annick Antierrens, Michel Van Herp, Stephan Günther, Xavier de Lamballerie, Sakoba Keïta, France Mentre, Xavier Anglaret, Denis Malvy, and JIKI Study Group

Subjects
Medicine
Abstract

[This corrects the article DOI: 10.1371/journal.pmed.1001967.].

Published
2016
Full Text
View/download PDF

9. Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea.

Author

Daouda Sissoko, Cedric Laouenan, Elin Folkesson, Abdoul-Bing M'Lebing, Abdoul-Habib Beavogui, Sylvain Baize, Alseny-Modet Camara, Piet Maes, Susan Shepherd, Christine Danel, Sara Carazo, Mamoudou N Conde, Jean-Luc Gala, Géraldine Colin, Hélène Savini, Joseph Akoi Bore, Frederic Le Marcis, Fara Raymond Koundouno, Frédéric Petitjean, Marie-Claire Lamah, Sandra Diederich, Alexis Tounkara, Geertrui Poelart, Emmanuel Berbain, Jean-Michel Dindart, Sophie Duraffour, Annabelle Lefevre, Tamba Leno, Olivier Peyrouset, Léonid Irenge, N'Famara Bangoura, Romain Palich, Julia Hinzmann, Annette Kraus, Thierno Sadou Barry, Sakoba Berette, André Bongono, Mohamed Seto Camara, Valérie Chanfreau Munoz, Lanciné Doumbouya, Souley Harouna, Patient Mumbere Kighoma, Fara Roger Koundouno, Réné Lolamou, Cécé Moriba Loua, Vincent Massala, Kinda Moumouni, Célia Provost, Nenefing Samake, Conde Sekou, Abdoulaye Soumah, Isabelle Arnould, Michel Saa Komano, Lina Gustin, Carlotta Berutto, Diarra Camara, Fodé Saydou Camara, Joliene Colpaert, Léontine Delamou, Lena Jansson, Etienne Kourouma, Maurice Loua, Kristian Malme, Emma Manfrin, André Maomou, Adele Milinouno, Sien Ombelet, Aboubacar Youla Sidiboun, Isabelle Verreckt, Pauline Yombouno, Anne Bocquin, Caroline Carbonnelle, Thierry Carmoi, Pierre Frange, Stéphane Mely, Vinh-Kim Nguyen, Delphine Pannetier, Anne-Marie Taburet, Jean-Marc Treluyer, Jacques Kolie, Raoul Moh, Minerva Cervantes Gonzalez, Eeva Kuisma, Britta Liedigk, Didier Ngabo, Martin Rudolf, Ruth Thom, Romy Kerber, Martin Gabriel, Antonino Di Caro, Roman Wölfel, Jamal Badir, Mostafa Bentahir, Yann Deccache, Catherine Dumont, Jean-François Durant, Karim El Bakkouri, Marie Gasasira Uwamahoro, Benjamin Smits, Nora Toufik, Stéphane Van Cauwenberghe, Khaled Ezzedine, Eric D'Ortenzio, Louis Pizarro, Aurélie Etienne, Jérémie Guedj, Alexandra Fizet, Eric Barte de Sainte Fare, Bernadette Murgue, Tuan Tran-Minh, Christophe Rapp, Pascal Piguet, Marc Poncin, Bertrand Draguez, Thierry Allaford Duverger, Solenne Barbe, Guillaume Baret, Isabelle Defourny, Miles Carroll, Hervé Raoul, Augustin Augier, Serge P Eholie, Yazdan Yazdanpanah, Claire Levy-Marchal, Annick Antierrens, Michel Van Herp, Stephan Günther, Xavier de Lamballerie, Sakoba Keïta, France Mentre, Xavier Anglaret, Denis Malvy, and JIKI Study Group

Subjects
Medicine
Abstract

BackgroundEbola virus disease (EVD) is a highly lethal condition for which no specific treatment has proven efficacy. In September 2014, while the Ebola outbreak was at its peak, the World Health Organization released a short list of drugs suitable for EVD research. Favipiravir, an antiviral developed for the treatment of severe influenza, was one of these. In late 2014, the conditions for starting a randomized Ebola trial were not fulfilled for two reasons. One was the perception that, given the high number of patients presenting simultaneously and the very high mortality rate of the disease, it was ethically unacceptable to allocate patients from within the same family or village to receive or not receive an experimental drug, using a randomization process impossible to understand by very sick patients. The other was that, in the context of rumors and distrust of Ebola treatment centers, using a randomized design at the outset might lead even more patients to refuse to seek care. Therefore, we chose to conduct a multicenter non-randomized trial, in which all patients would receive favipiravir along with standardized care. The objectives of the trial were to test the feasibility and acceptability of an emergency trial in the context of a large Ebola outbreak, and to collect data on the safety and effectiveness of favipiravir in reducing mortality and viral load in patients with EVD. The trial was not aimed at directly informing future guidelines on Ebola treatment but at quickly gathering standardized preliminary data to optimize the design of future studies.Methods and findingsInclusion criteria were positive Ebola virus reverse transcription PCR (RT-PCR) test, age ≥ 1 y, weight ≥ 10 kg, ability to take oral drugs, and informed consent. All participants received oral favipiravir (day 0: 6,000 mg; day 1 to day 9: 2,400 mg/d). Semi-quantitative Ebola virus RT-PCR (results expressed in "cycle threshold" [Ct]) and biochemistry tests were performed at day 0, day 2, day 4, end of symptoms, day 14, and day 30. Frozen samples were shipped to a reference biosafety level 4 laboratory for RNA viral load measurement using a quantitative reference technique (genome copies/milliliter). Outcomes were mortality, viral load evolution, and adverse events. The analysis was stratified by age and Ct value. A "target value" of mortality was defined a priori for each stratum, to guide the interpretation of interim and final analysis. Between 17 December 2014 and 8 April 2015, 126 patients were included, of whom 111 were analyzed (adults and adolescents, ≥13 y, n = 99; young children, ≤6 y, n = 12). Here we present the results obtained in the 99 adults and adolescents. Of these, 55 had a baseline Ct value ≥ 20 (Group A Ct ≥ 20), and 44 had a baseline Ct value < 20 (Group A Ct < 20). Ct values and RNA viral loads were well correlated, with Ct = 20 corresponding to RNA viral load = 7.7 log10 genome copies/ml. Mortality was 20% (95% CI 11.6%-32.4%) in Group A Ct ≥ 20 and 91% (95% CI 78.8%-91.1%) in Group A Ct < 20. Both mortality 95% CIs included the predefined target value (30% and 85%, respectively). Baseline serum creatinine was ≥110 μmol/l in 48% of patients in Group A Ct ≥ 20 (≥300 μmol/l in 14%) and in 90% of patients in Group A Ct < 20 (≥300 μmol/l in 44%). In Group A Ct ≥ 20, 17% of patients with baseline creatinine ≥110 μmol/l died, versus 97% in Group A Ct < 20. In patients who survived, the mean decrease in viral load was 0.33 log10 copies/ml per day of follow-up. RNA viral load values and mortality were not significantly different between adults starting favipiravir within ConclusionsIn the context of an outbreak at its peak, with crowded care centers, randomizing patients to receive either standard care or standard care plus an experimental drug was not felt to be appropriate. We did a non-randomized trial. This trial reaches nuanced conclusions. On the one hand, we do not conclude on the efficacy of the drug, and our conclusions on tolerance, although encouraging, are not as firm as they could have been if we had used randomization. On the other hand, we learned about how to quickly set up and run an Ebola trial, in close relationship with the community and non-governmental organizations; we integrated research into care so that it improved care; and we generated knowledge on EVD that is useful to further research. Our data illustrate the frequency of renal dysfunction and the powerful prognostic value of low Ct values. They suggest that drug trials in EVD should systematically stratify analyses by baseline Ct value, as a surrogate of viral load. They also suggest that favipiravir monotherapy merits further study in patients with medium to high viremia, but not in those with very high viremia.Trial registrationClinicalTrials.gov NCT02329054.

Published
2016
Full Text
View/download PDF

10. The Atrial Fibrillation Ablation Pilot Study: an European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association

Author

Arbelo, Elena, Brugada, Josep, Hindricks, Gerhard, Maggioni, Aldo P., Tavazzi, Luigi, Vardas, Panos, Laroche, Cécile, Anselme, Frédéric, Inama, Giuseppe, Jais, Pierre, Kalarus, Zbigniew, Kautzner, Josef, Lewalter, Thorsten, Mairesse, Georges H., Perez-Villacastin, Julian, Riahi, Sam, Taborsky, Milos, Theodorakis, George, Trines, Serge A., Brugada, Josep, Arbelo, Elena, Hindriks, Gerhard, Maggioni, Aldo P., Morgan, John, Tavazzi, Luigi, Vardas, Panos, Alonso, Angeles, Ferrari, Roberto, Komajda, Michel, Tavazzi, Luigi, Wood, David, Vardas, Panos, Brugada, Josep, Mairesse, Georges, Taborsky, Milos, Kautzner, Josef, Lewalter, Thorsten, Riahi, Sam, Jais, Pierre, Anselme, Frédéric, Theodorakis, George, Inama, Giuseppe, Trines, Serge, Kalarus, Zbigniew, Villacastin, Julian Perez, Maggioni, Aldo P., Manini, Malika, Gracia, Gérard, Laroche, Cécile, Missiamenou, Viviane, Taylor, Charles, Konte, Marème, Fiorucci, Emanuela, Lefrancq, Elin Folkesson, Glémot, Myriam, McNeill, Patti-Ann, Bois, Timothée, Heidbüchel, H., Nuyens, D., Boland, J., Dinraths, V., Herzet, J.-M., Hoffer, E., Malmendier, D., Massoz, M., Pourbaix, S., Ballant, E., Blommaert, D., Deceuninck, O., Dormal, F., Xhaet, O., De Potter, T., Geelen, P., Derycker, K., Duytschaever, M., Tavernier, R., Vandekerckhove, Y., Vankats, D., Bulava, A., Hanis, J., Sitek, D., Blahova, M., Cihak, R., Hanyasova, L., Jansova, H., Peichl, P., Tanzerova, M., Wichterle, D., Duda, J., Haman, L., Parizek, P., Coling, L., Neuzil, P., Petru, J., Sediva, L., Skoda, J., Chovancik, J., Fiala, M., Neuwirth, R., Karlsdottir, A., Pehrson, S., Gerdes, C., Jensen, H.K., Lukac, P., Nielsen, J. C., Hansen, J., Johannessen, A., Hansen, P. S., Pedersen, A.K., Heath, F.P., Hjortshoj, S., Thogersen, A.M., Da Costa, A., Martel, I., Romeyer-Bouchard, C., Sadki, N., Schmid, A., Haissaguerre, M., Hocini, M., Knecht, S., Sacher, F., Ait Said, M., Cauchemez, B., Ledoux, F., Thomas, O., Cebron, J.-P., Decarsin, N., Gras, D., Hervouet, S., Durand, C., Durand-Dubief, A., Poty, H., Babuty, D., Pierre, B., Albenque, J.-P., Boveda, S., Combes, N., Mas, R., Hermida, J-S., Kubala, M., Godin, B., Savouré, A., Soublin, Y., Defaye, P., Jacon, P., Brigadeau, F., Corbut, S., Flament-Balzola, F., Kacet, S., Klug, D., Lacroix, D., Copie, X., Gilles, L., Hocine, Z., Paziaud, O., Piot, O., Crocq, C., Kaballu, G., Le Moal, V., Lotton, P., Mabo, P., Pavin, D., Andronache, M., De Chillou, C., Magnin-Poull, I., Deharo, J.-C., Durand, C., Franceschi, F., Peyrouse, E., Prevot, S., Etchegoin, M., Extramiana, F., Leenhardt, A., Messali, A., Heine, T., Schneider, A., Winter, N., Brachmann, J., Ritscher, G., Schertel-Gruenler, B., Simon, H., Sinha, A.-M., Turschner, O., Wystrach, A., Stemberg, M., Kuck, K.-H., Metzner, A., Tilz, R., Wissner, E., Heitmann, K., Willems, S., Andresen, D., Mueller, S., Volkmer, M., Schmidt, B., Kostopoulou, A., Livanis, E., Voudris, V., Efremidis, M., Letsas, K., Tsikrikas, S., Christoforatou, E., Ioannidis, P., Katsivas, A., Kourouklis, S., Andrikopoulos, G., Rassias, I., Tzeis, S., Dakos, G., Paraskevaidis, S., Stavropoulos, G., Theofilogiannakos, E., Vassilikos, V.P., Bongiorni, M.G., Zucchelli, G., Raviele, A., Themistoclakis, S., Pratola, C., Tritto, M., Della Bella, P., Mazzone, P., Moltrasio, M., Tondo, C., Calo, L., De Luca, L., Guarracini, F., Lioy, E., Dozza, L., Frigoli, E., Giannelli, L., Pappone, C., Saviano, M., Schiavina, G., Vicedomini, G.G., De Ponti, R., Doni, L. A., Marazzi, R., Salerno-Uriarte, J.A., Tamborini, C., Anselmino, M., Ferraris, F., Gaita, F., Bertaglia, E., Brandolino, G., Zoppo, F., De Groot, N., Janse, P., Jordaens, L., Pison, L., Roos, C., Van Gelder, I., Manusama, R., Meijer, A., Van der Voort, P., Trines, S., Compier, Marieke G., Kazmierczak, J., Kornacewicz-Jach, Z., Wielusinski, M., Baran, J., Kulakowski, P., Dzidowski, M., Fuglewicz, A., Nowak, K., Pruszkowska-Skrzep, P., Wozniak, A., Nowak, S., Trusz-Gluza, M., Almendral, J., Atienza, F., Castellanos, E., De Diego, C., Ortiz, M., Moreno Planas, J., Perez Castellano, N., Benezet, J., Farre Muncharaz, J., Rubio Campal, J.M., Hernandez Madrid, A., Matia, R., Arana, E., Pedrote, A., Cozar, R., Peinado, R., Valverde, I., Arbelo, E., Berruezo, A., Calvo, N., Guiu, E., Husseini, S., and Mont Girbau, L.

Published
2014
Full Text
View/download PDF

11. Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

Author

Van Hagen, Iris M., Baart, Sara, Fong Soe Khioe, Rebekah, Sliwa-Hahnle, Karen, Taha, Nasser, Lelonek, Malgorzata, Tavazzi, Luigi, Maggioni, Aldo Pietro, Johnson, Mark R., Maniadakis, Nikolaos, Fordham, Richard, Hall, Roger, Roos-Hesselink, Jolien W., Ferrari, Roberto, Marelli, Ariane, Webb, Gary, Kaemmerer, Harald, Popelova, Jana, Sliwa, Karen, Parsonage, William Anthony, Stein, Joerg, Elkayam, Uri, Thilen, Ulf, Budts, Werner, Ruys, Titia, Vardas, Panos, Komajda, Michel, Pinto, Fausto, Alonso, Angeles, Wood, David, Ferreira, Thierry, Gracia, Gérard, Laroche, Cécile, Missiamenou, Viviane, Taylor, Charles, Konte, Marème, Andarala, Maryna, Fiorucci, Emanuela, Lefrancq, Elin Folkesson, Glémot, Myriam, McNeill, Patti Ann, Pommier, Caroline, Lafay, Myriam, Aquieri, A., Vega, H. Ruda, Blanco, M. Vázquez, Lust, K., Fagermo, N., Gabriel, H., Donhauser, E., Gasimov, Z., Jahangirov, T., Hasanova, I., De Backer, J., Demulier, L., de Hosson, M., Beckx, M., Moissens, M., Kovacevic-Preradovic, T., Kozic, M., Lovric, M., Freire, C. Vilas, Chilingirova, N., Kratunkov, P., Montesclaros, A. R., Beaubien, E., Gordon, E., Walter, L., Lindsay, C., Wahab, N., Vavera, Z., El Nagar, A., Ebaid, H. H., El Sayed Makled, W. A., Dardier, A., Shabaan, M., Elrakshy, Y., Eltamawey, K., Abd-El Aziz, M. Gamal, Saad, A., Aboleineen, W., Ashour, Z., Sorour, K., Mahdy, M. A.Meguid, Iserin, L., Ladouceur, M., Cohen, S., Iung, B., Maisuradze, D., Mebus, S., Gembruch, U., Hammerstingl, C., Merz, W. M., Wald, C., Baumgartner, H., Orwat, S., Schmidt, R., Motz, R., Olsson, A., Berger, F., Nagdyman, N., Frogoudaki, A., Anastasiou-Nana, M., Temesvari, A., Kohalmi, D., Balint, H., Merkely, B., Liptai, C., Bowen, M., Cullen, M., Thornton, P., Husarova, V., Blatt, A., Elbaz-Greener, G., Moravsky, G., Vered, Z., Fuhrmann, A. Vazan, Shotan, A., Goland, S., Festa, P., Ali, L. Ait, Sinagra, G., Puggia, I., Mottolese, B. D.Agata, Carmina, M. G., Romeo, C., Crepaz, R., Fesslova, V., Azzarelli, A., Baldi, D., Bovenzi, F., Donvito, V., Vasario, E., Todros, T., Niwa, K., Mussagaliyeva, A., Mekebekova, D., Sharipova, S., Zaliunas, R., Jonkaitiene, R., Petrauskaite, J., Gumbiene, L., Jovanova, S., Cassar, A., Caruana, M., Karamermer, Y., Cornette, J. M.J., van Dijk, A., Bellersen, L., Duijnhouwer, T., De Groot, C., Pieper, E. P.G., van Oppen, C., Polak, P., Wajon, E., Wagenaar, L., Estensen, M., Lesniak-Sobelga, A., Podolec, P., Wisniowska-Smialek, S., Trybuch, A., Hoffman, P., Cichocka-Radwan, A., Sobczak, S., Faflik, U., Tomaszuk-Kazberuk, A., Przepiesc, J., Gil, M., Plaskota, K., Trojnarska, O., Guerra, N., de Sousa, L., Petrescu, V., Ginghina, C., Jurcut, R., Coman, I. Mircea, Gaisin, I. Ravilevich, Shilina, L. Valeryevna, Sharashkina, N., Tkacheva, O., Ivanov, D., Irtyuga, O., Jovovic, L., Prokselj, K., Kozelj, M., Elliott, C., Galian-Gay, L., Pijuan-Domenech, A., Subirana-Domenech, M. T., Tornos, P., Murga, N., Oliver, J. M., Escribano-Subías, P., Ruiz-Cano, M. J., Delgado-Jiménez, J., Furenas, E., Dellborg, M., Thilén, U., Schwerzmann, M., Bouchardy, J., Rutz, T., Tobler, D., Sarac, L., Esen, O. Batukan, Enar, S. Catirli, Al Mulla, A., Bazargani, N., Al Hatou, E., Farook, F., Almahmeed, W., Salih, B., Clifford, P., Bowers, N., Veldtman, G., Kerr, J., Tellett, L., Hudsmith, L., Thompson, P., Thorne, S., Bowater, S., Nihoyannopoulos, P., Curry, R., Freeman, L., Schroeder, F., Wendler, R., Hammond, S., Talluto, C., Murphy, D., Perlroth, M. G., Chintala, K., Gupta, P., Pare, E., Khatri, N., Scott, N., De Faria-Yeh, D., Bhatt, A. B., Tsiaras, S., Gurvitz, M., Otto, C., Botti, J., Ting, J., Davidson, W. R., Van Hagen, Iris M., Baart, Sara, Fong Soe Khioe, Rebekah, Sliwa-Hahnle, Karen, Taha, Nasser, Lelonek, Malgorzata, Tavazzi, Luigi, Maggioni, Aldo Pietro, Johnson, Mark R., Maniadakis, Nikolaos, Fordham, Richard, Hall, Roger, Roos-Hesselink, Jolien W., Ferrari, Roberto, Marelli, Ariane, Webb, Gary, Kaemmerer, Harald, Popelova, Jana, Sliwa, Karen, Parsonage, William Anthony, Stein, Joerg, Elkayam, Uri, Thilen, Ulf, Budts, Werner, Ruys, Titia, Vardas, Panos, Komajda, Michel, Pinto, Fausto, Alonso, Angeles, Wood, David, Ferreira, Thierry, Gracia, Gérard, Laroche, Cécile, Missiamenou, Viviane, Taylor, Charles, Konte, Marème, Andarala, Maryna, Fiorucci, Emanuela, Lefrancq, Elin Folkesson, Glémot, Myriam, McNeill, Patti Ann, Pommier, Caroline, Lafay, Myriam, Aquieri, A., Vega, H. Ruda, Blanco, M. Vázquez, Lust, K., Fagermo, N., Gabriel, H., Donhauser, E., Gasimov, Z., Jahangirov, T., Hasanova, I., De Backer, J., Demulier, L., de Hosson, M., Beckx, M., Moissens, M., Kovacevic-Preradovic, T., Kozic, M., Lovric, M., Freire, C. Vilas, Chilingirova, N., Kratunkov, P., Montesclaros, A. R., Beaubien, E., Gordon, E., Walter, L., Lindsay, C., Wahab, N., Vavera, Z., El Nagar, A., Ebaid, H. H., El Sayed Makled, W. A., Dardier, A., Shabaan, M., Elrakshy, Y., Eltamawey, K., Abd-El Aziz, M. Gamal, Saad, A., Aboleineen, W., Ashour, Z., Sorour, K., Mahdy, M. A.Meguid, Iserin, L., Ladouceur, M., Cohen, S., Iung, B., Maisuradze, D., Mebus, S., Gembruch, U., Hammerstingl, C., Merz, W. M., Wald, C., Baumgartner, H., Orwat, S., Schmidt, R., Motz, R., Olsson, A., Berger, F., Nagdyman, N., Frogoudaki, A., Anastasiou-Nana, M., Temesvari, A., Kohalmi, D., Balint, H., Merkely, B., Liptai, C., Bowen, M., Cullen, M., Thornton, P., Husarova, V., Blatt, A., Elbaz-Greener, G., Moravsky, G., Vered, Z., Fuhrmann, A. Vazan, Shotan, A., Goland, S., Festa, P., Ali, L. Ait, Sinagra, G., Puggia, I., Mottolese, B. D.Agata, Carmina, M. G., Romeo, C., Crepaz, R., Fesslova, V., Azzarelli, A., Baldi, D., Bovenzi, F., Donvito, V., Vasario, E., Todros, T., Niwa, K., Mussagaliyeva, A., Mekebekova, D., Sharipova, S., Zaliunas, R., Jonkaitiene, R., Petrauskaite, J., Gumbiene, L., Jovanova, S., Cassar, A., Caruana, M., Karamermer, Y., Cornette, J. M.J., van Dijk, A., Bellersen, L., Duijnhouwer, T., De Groot, C., Pieper, E. P.G., van Oppen, C., Polak, P., Wajon, E., Wagenaar, L., Estensen, M., Lesniak-Sobelga, A., Podolec, P., Wisniowska-Smialek, S., Trybuch, A., Hoffman, P., Cichocka-Radwan, A., Sobczak, S., Faflik, U., Tomaszuk-Kazberuk, A., Przepiesc, J., Gil, M., Plaskota, K., Trojnarska, O., Guerra, N., de Sousa, L., Petrescu, V., Ginghina, C., Jurcut, R., Coman, I. Mircea, Gaisin, I. Ravilevich, Shilina, L. Valeryevna, Sharashkina, N., Tkacheva, O., Ivanov, D., Irtyuga, O., Jovovic, L., Prokselj, K., Kozelj, M., Elliott, C., Galian-Gay, L., Pijuan-Domenech, A., Subirana-Domenech, M. T., Tornos, P., Murga, N., Oliver, J. M., Escribano-Subías, P., Ruiz-Cano, M. J., Delgado-Jiménez, J., Furenas, E., Dellborg, M., Thilén, U., Schwerzmann, M., Bouchardy, J., Rutz, T., Tobler, D., Sarac, L., Esen, O. Batukan, Enar, S. Catirli, Al Mulla, A., Bazargani, N., Al Hatou, E., Farook, F., Almahmeed, W., Salih, B., Clifford, P., Bowers, N., Veldtman, G., Kerr, J., Tellett, L., Hudsmith, L., Thompson, P., Thorne, S., Bowater, S., Nihoyannopoulos, P., Curry, R., Freeman, L., Schroeder, F., Wendler, R., Hammond, S., Talluto, C., Murphy, D., Perlroth, M. G., Chintala, K., Gupta, P., Pare, E., Khatri, N., Scott, N., De Faria-Yeh, D., Bhatt, A. B., Tsiaras, S., Gurvitz, M., Otto, C., Botti, J., Ting, J., and Davidson, W. R.

Abstract

Objective Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease. Methods The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country). Results A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate. Conclusion While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome.

Published
2018

12. Pulmonary hypertension and pregnancy outcomes: Data from the Registry of Pregnancy and Cardiac Disease (ROPAC) of the European Society of Cardiology

Author

Sliwa, Karen, van Hagen, Iris M., Budts, Werner, Swan, Lorna, Sinagra, Gianfranco, Caruana, Maryanne, Blanco, Manuel Vazquez, Wagenaar, Lodewijk J., Johnson, Mark R., Webb, Gary, Hall, Roger, Roos-Hesselink, Jolien W., Ferrari, Roberto, Maggioni, Aldo P., Marelli, Ariane, Kaemmerer, Harald, Popelova, Jana, Tavazzi, Luigi, Parsonage, William Anthony, Stein, Joerg, Elkayam, Uri, Thilen, Ulf, Ruys, Titia, Vardas, Panos, Komajda, Michel, Pinto, Fausto, Alonso, Angeles, Wood, David, Maniadakis, Nikolaos, Ferreira, Thierry, Gracia, Gérard, Laroche, Cécile, Missiamenou, Viviane, Taylor, Charles, Konte, Marème, Andarala, Maryna, Fiorucci, Emanuela, Lefrancq, Elin Folkesson, Glémot, Myriam, McNeill, Patti Ann, Pommier, Caroline, Lafay, Myriam, Aquieri, A., Vega, H. Ruda, Lust, K., Fagermo, N., Gabriel, H., Donhauser, E., Gasimov, Z., Jahangirov, T., Hasanova, I., De Backer, J., Demulier, L., de Hosson, M., Beckx, M., Moissens, M., Kovacevic-Preradovic, T., Kozic, M., Lovric, M., Freire, C. Vilas, Chilingirova, N., Kratunkov, P., Montesclaros, A. R., Beaubien, E., Gordon, E., Walter, L., Lindsay, C., Wahab, N., Vavera, Z., El Nagar, A., Ebaid, H. H., El Sayed Makled, W. A., Taha, N., Dardier, A., Shabaan, M., Elrakshy, Y., Eltamawey, K., Abd-El Aziz, M. Gamal, Saad, Aly, Aboleineen, W., Ashour, Z., Sorour, K., Mahdy, M. A.Meguid, Iserin, L., Ladouceur, M., Cohen, S., Iung, B., Maisuradze, D., Mebus, S., Gembruch, U., Hammerstingl, C., Merz, W. M., Wald, C., Baumgartner, H., Orwat, S., Schmidt, R., Motz, R., Olsson, A., Berger, F., Nagdyman, N., Frogoudaki, A., Anastasiou-Nana, M., Temesvari, A., Kohalmi, D., Balint, H., Merkely, B., Liptai, C., Bowen, M., Cullen, M., Thornton, P., Husarova, V., Blatt, A., Elbaz-Greener, G., Moravsky, G., Vered, Z., Fuhrmann, A. Vazan, Shotan, A., Goland, S., Festa, P., Ali, L. Ait, Puggia, I., Mottolese, B. D.Agata, Carmina, M. G., Romeo, C., Crepaz, R., Fesslova, V., Azzarelli, A., Baldi, D., Bovenzi, F., Donvito, V., Vasario, E., Todros, T., Niwa, K., Mussagaliyeva, A., Mekebekova, D., Sharipova, S., Zaliunas, R., Jonkaitiene, R., Petrauskaite, J., Gumbiene, L., Jovanova, S., Cassar, A., Karamermer, Y., Cornette, J. M.J., van Dijk, A., Bellersen, L., Duijnhouwer, T., De Groot, C., Pieper, E. P.G., van Oppen, C., Polak, P., Wajon, E., Estensen, M., Lesniak-Sobelga, A., Podolec, P., Wisniowska-Smialek, S., Trybuch, A., Hoffman, P., Cichocka-Radwan, A., Lelonek, M., Sobczak, S., Faflik, U., Tomaszuk-Kazberuk, A., Przepiesc, J., Gil, M., Plaskota, K., Trojnarska, O., Guerra, N., de Sousa, L., Petrescu, V., Ginghina, C., Jurcut, R., Coman, I. Mircea, Gaisin, I. Ravilevich, Shilina, L. Valeryevna, Sharashkina, N., Tkacheva, O., Ivanov, D., Irtyuga, O., Jovovic, L., Prokselj, K., Kozelj, M., Elliott, C., Galian-Gay, L., Pijuan-Domenech, A., Subirana-Domenech, M. T., Tornos, P., Murga, N., Oliver, J. M., Escribano-Subías, P., Ruiz-Cano, M. J., Delgado-Jiménez, J., Furenas, E., Dellborg, M., Thilén, U., Schwerzmann, M., Bouchardy, J., Rutz, T., Tobler, D., Sarac, L., Esen, O. Batukan, Enar, S. Catirli, Al Mulla, A., Bazargani, N., Al Hatou, E., Farook, F., Almahmeed, W., Salih, B., Clifford, P., Bowers, N., Veldtman, G., Kerr, J., Tellett, L., Hudsmith, L., Thompson, P., Thorne, S., Bowater, S., Nihoyannopoulos, P., Curry, R., Freeman, L., Schroeder, F., Wendler, R., Hammond, S., Talluto, C., Murphy, D., Perlroth, M. G., Chintala, K., Gupta, P., Pare, E., Khatri, N., Scott, N., De Faria-Yeh, D., Bhatt, A. B., Tsiaras, S., Gurvitz, M., Otto, C., Botti, J., Ting, J., Davidson, W. R., Sliwa, Karen, van Hagen, Iris M., Budts, Werner, Swan, Lorna, Sinagra, Gianfranco, Caruana, Maryanne, Blanco, Manuel Vazquez, Wagenaar, Lodewijk J., Johnson, Mark R., Webb, Gary, Hall, Roger, Roos-Hesselink, Jolien W., Ferrari, Roberto, Maggioni, Aldo P., Marelli, Ariane, Kaemmerer, Harald, Popelova, Jana, Tavazzi, Luigi, Parsonage, William Anthony, Stein, Joerg, Elkayam, Uri, Thilen, Ulf, Ruys, Titia, Vardas, Panos, Komajda, Michel, Pinto, Fausto, Alonso, Angeles, Wood, David, Maniadakis, Nikolaos, Ferreira, Thierry, Gracia, Gérard, Laroche, Cécile, Missiamenou, Viviane, Taylor, Charles, Konte, Marème, Andarala, Maryna, Fiorucci, Emanuela, Lefrancq, Elin Folkesson, Glémot, Myriam, McNeill, Patti Ann, Pommier, Caroline, Lafay, Myriam, Aquieri, A., Vega, H. Ruda, Lust, K., Fagermo, N., Gabriel, H., Donhauser, E., Gasimov, Z., Jahangirov, T., Hasanova, I., De Backer, J., Demulier, L., de Hosson, M., Beckx, M., Moissens, M., Kovacevic-Preradovic, T., Kozic, M., Lovric, M., Freire, C. Vilas, Chilingirova, N., Kratunkov, P., Montesclaros, A. R., Beaubien, E., Gordon, E., Walter, L., Lindsay, C., Wahab, N., Vavera, Z., El Nagar, A., Ebaid, H. H., El Sayed Makled, W. A., Taha, N., Dardier, A., Shabaan, M., Elrakshy, Y., Eltamawey, K., Abd-El Aziz, M. Gamal, Saad, Aly, Aboleineen, W., Ashour, Z., Sorour, K., Mahdy, M. A.Meguid, Iserin, L., Ladouceur, M., Cohen, S., Iung, B., Maisuradze, D., Mebus, S., Gembruch, U., Hammerstingl, C., Merz, W. M., Wald, C., Baumgartner, H., Orwat, S., Schmidt, R., Motz, R., Olsson, A., Berger, F., Nagdyman, N., Frogoudaki, A., Anastasiou-Nana, M., Temesvari, A., Kohalmi, D., Balint, H., Merkely, B., Liptai, C., Bowen, M., Cullen, M., Thornton, P., Husarova, V., Blatt, A., Elbaz-Greener, G., Moravsky, G., Vered, Z., Fuhrmann, A. Vazan, Shotan, A., Goland, S., Festa, P., Ali, L. Ait, Puggia, I., Mottolese, B. D.Agata, Carmina, M. G., Romeo, C., Crepaz, R., Fesslova, V., Azzarelli, A., Baldi, D., Bovenzi, F., Donvito, V., Vasario, E., Todros, T., Niwa, K., Mussagaliyeva, A., Mekebekova, D., Sharipova, S., Zaliunas, R., Jonkaitiene, R., Petrauskaite, J., Gumbiene, L., Jovanova, S., Cassar, A., Karamermer, Y., Cornette, J. M.J., van Dijk, A., Bellersen, L., Duijnhouwer, T., De Groot, C., Pieper, E. P.G., van Oppen, C., Polak, P., Wajon, E., Estensen, M., Lesniak-Sobelga, A., Podolec, P., Wisniowska-Smialek, S., Trybuch, A., Hoffman, P., Cichocka-Radwan, A., Lelonek, M., Sobczak, S., Faflik, U., Tomaszuk-Kazberuk, A., Przepiesc, J., Gil, M., Plaskota, K., Trojnarska, O., Guerra, N., de Sousa, L., Petrescu, V., Ginghina, C., Jurcut, R., Coman, I. Mircea, Gaisin, I. Ravilevich, Shilina, L. Valeryevna, Sharashkina, N., Tkacheva, O., Ivanov, D., Irtyuga, O., Jovovic, L., Prokselj, K., Kozelj, M., Elliott, C., Galian-Gay, L., Pijuan-Domenech, A., Subirana-Domenech, M. T., Tornos, P., Murga, N., Oliver, J. M., Escribano-Subías, P., Ruiz-Cano, M. J., Delgado-Jiménez, J., Furenas, E., Dellborg, M., Thilén, U., Schwerzmann, M., Bouchardy, J., Rutz, T., Tobler, D., Sarac, L., Esen, O. Batukan, Enar, S. Catirli, Al Mulla, A., Bazargani, N., Al Hatou, E., Farook, F., Almahmeed, W., Salih, B., Clifford, P., Bowers, N., Veldtman, G., Kerr, J., Tellett, L., Hudsmith, L., Thompson, P., Thorne, S., Bowater, S., Nihoyannopoulos, P., Curry, R., Freeman, L., Schroeder, F., Wendler, R., Hammond, S., Talluto, C., Murphy, D., Perlroth, M. G., Chintala, K., Gupta, P., Pare, E., Khatri, N., Scott, N., De Faria-Yeh, D., Bhatt, A. B., Tsiaras, S., Gurvitz, M., Otto, C., Botti, J., Ting, J., and Davidson, W. R.

Abstract

Aims: To describe the outcomes of pregnancy in women with pulmonary hypertension. Methods and results: In 2007 the European Registry on Pregnancy and Heart Disease was initiated by the European Society of Cardiology. Consecutive patients with all forms of cardiovascular disease, presenting with pregnancy, were enrolled with the aim of investigating the pregnancy outcomes. This subgroup of the cohort included 151 women with pulmonary hypertension (PH) either diagnosed by right heart catheterization or diagnosed as possible PH by echocardiographic signs, with 26% having pulmonary arterial hypertension (PAH), in three subgroups: idiopathic (iPAH), associated with congenital heart disease (CHD-PAH), or associated with other disease (oPAH), and 74% having PH caused by left heart disease (LHD-PH, n = 112). Maternal mean age was 29.2 ± 5.6 years and 37% were nulliparous. Right ventricular systolic pressure was <50 mmHg in 59.6% of patients, 50–70 mmHg in 28.5% and >70 mmHg in 11.9%. In more than 75% of patients, the diagnosis of PH had been made before pregnancy. Maternal death up to 1 week after delivery occurred in five patients (3.3%), with another two out of 78 patients who presented for follow-up (2.6%), dying within 6 months after delivery. The highest mortality was found in iPAH (3/7, 43%). During pregnancy, heart failure occurred in 27%. Caesarean section was performed in 63.4% (23.9% as emergency). Therapeutic abortion was performed in 4.0%. Complications included miscarriage (5.6%), fetal mortality (2%), premature delivery (21.7%), low birth weight (19.0%), and neonatal mortality (0.7%). Conclusion: Mortality in this group of patients with various forms of PH was lower than previously reported as specialized care during pregnancy and delivery was available. However, maternal and fetal mortality remains prohibitively high in women with iPAH, although this conclusion is restricted by limited numbers. Early advice on c

Published
2016

13. Risk of pregnancy in moderate and severe aortic stenosis: From the multinational ROPAC registry

Author

Orwat, Stefan, Diller, Gerhard Paul, van Hagen, Iris M., Schmidt, Renate, Tobler, Daniel, Greutmann, Matthias, Jonkaitiene, Regina, Elnagar, Amro, Johnson, Mark R., Hall, Roger, Roos-Hesselink, Jolien W., Baumgartner, Helmut, Ferrari, Roberto, Maggioni, Aldo P., Marelli, Ariane, Webb, Gary, Kaemmerer, Harald, Popelova, Jana, Sliwa, Karen, Tavazzi, Luigi, Parsonage, William Anthony, Stein, Joerg, Elkayam, Uri, Thilen, Ulf, Budts, Werner, Ruys, Titia, Vardas, Panos, Komajda, Michel, Pinto, Fausto, Alonso, Angeles, Wood, David, Maniadakis, Nikolaos, Ferreira, Thierry, Gracia, Gérard, Laroche, Cécile, Missiamenou, Viviane, Taylor, Charles, Konte, Marème, Andarala, Maryna, Fiorucci, Emanuela, Lefrancq, Elin Folkesson, Glémot, Myriam, McNeill, Patti Ann, Pommier, Caroline, Lafay, Myriam, Aquieri, A., Vega, H. Ruda, Blanco, M. Vázquez, Lust, K., Fagermo, N., Gabriel, H., Donhauser, E., Gasimov, Z., Jahangirov, T., Hasanova, I., De Backer, J., Demulier, L., de Hosson, M., Beckx, M., Moissens, M., Kovacevic-Preradovic, T., Kozic, M., Lovric, M., Freire, C. Vilas, Chilingirova, N., Kratunkov, P., Montesclaros, A. R., Beaubien, E., Gordon, E., Walter, L., Lindsay, C., Wahab, N., Vavera, Z., El Nagar, A., Ebaid, H. H., El Sayed Makled, W. A., Taha, N., Dardier, A., Shabaan, M., Elrakshy, Y., Eltamawey, K., Abd-El Aziz, M. Gamal, Saad, A., Aboleineen, W., Ashour, Z., Sorour, K., Mahdy, M. A.Meguid, Iserin, L., Ladouceur, M., Cohen, S., Iung, B., Maisuradze, D., Mebus, S., Gembruch, U., Hammerstingl, C., Merz, W. M., Wald, C., Motz, R., Olsson, A., Berger, F., Nagdyman, N., Frogoudaki, A., Anastasiou-Nana, M., Temesvari, A., Kohalmi, D., Balint, H., Merkely, B., Liptai, C., Bowen, M., Cullen, M., Thornton, P., Husarova, V., Blatt, A., Elbaz-Greener, G., Moravsky, G., Vered, Z., Fuhrmann, A. Vazan, Shotan, A., Goland, S., Festa, P., Ali, L. Ait, Sinagra, G., Puggia, I., Mottolese, B. D.Agata, Carmina, M. G., Romeo, C., Crepaz, R., Fesslova, V., Azzarelli, A., Baldi, D., Bovenzi, F., Donvito, V., Vasario, E., Todros, T., Niwa, K., Mussagaliyeva, A., Mekebekova, D., Sharipova, S., Zaliunas, R., Petrauskaite, J., Gumbiene, L., Jovanova, S., Cassar, A., Caruana, M., Karamermer, Y., Cornette, J. M.J., van Dijk, A., Bellersen, L., Duijnhouwer, T., De Groot, C., Pieper, E. P.G., van Oppen, C., Polak, P., Wajon, E., Wagenaar, L., Estensen, M., Lesniak-Sobelga, A., Podolec, P., Wisniowska-Smialek, S., Trybuch, A., Hoffman, P., Cichocka-Radwan, A., Lelonek, M., Sobczak, S., Faflik, U., Tomaszuk-Kazberuk, A., Przepiesc, J., Gil, M., Plaskota, K., Trojnarska, O., Guerra, N., de Sousa, L., Petrescu, V., Ginghina, C., Jurcut, R., Coman, I. Mircea, Gaisin, I. Ravilevich, Shilina, L. Valeryevna, Sharashkina, N., Tkacheva, O., Ivanov, D., Irtyuga, O., Jovovic, L., Prokselj, K., Kozelj, M., Elliott, C., Galian-Gay, L., Pijuan-Domenech, A., Subirana-Domenech, M. T., Tornos, P., Murga, N., Oliver, J. M., Escribano-Subías, P., Ruiz-Cano, M. J., Delgado-Jiménez, J., Furenas, E., Dellborg, M., Thilén, U., Schwerzmann, M., Bouchardy, J., Rutz, T., Sarac, L., Esen, O. Batukan, Enar, S. Catirli, Al Mulla, A., Bazargani, N., Al Hatou, E., Farook, F., Almahmeed, W., Salih, B., Clifford, P., Bowers, N., Veldtman, G., Kerr, J., Tellett, L., Hudsmith, L., Thompson, P., Thorne, S., Bowater, S., Nihoyannopoulos, P., Curry, R., Freeman, L., Schroeder, F., Wendler, R., Hammond, S., Talluto, C., Murphy, D., Perlroth, M. G., Chintala, K., Gupta, P., Pare, E., Khatri, N., Scott, N., De Faria-Yeh, D., Bhatt, A. B., Tsiaras, S., Gurvitz, M., Otto, C., Botti, J., Ting, J., Davidson, W. R., Orwat, Stefan, Diller, Gerhard Paul, van Hagen, Iris M., Schmidt, Renate, Tobler, Daniel, Greutmann, Matthias, Jonkaitiene, Regina, Elnagar, Amro, Johnson, Mark R., Hall, Roger, Roos-Hesselink, Jolien W., Baumgartner, Helmut, Ferrari, Roberto, Maggioni, Aldo P., Marelli, Ariane, Webb, Gary, Kaemmerer, Harald, Popelova, Jana, Sliwa, Karen, Tavazzi, Luigi, Parsonage, William Anthony, Stein, Joerg, Elkayam, Uri, Thilen, Ulf, Budts, Werner, Ruys, Titia, Vardas, Panos, Komajda, Michel, Pinto, Fausto, Alonso, Angeles, Wood, David, Maniadakis, Nikolaos, Ferreira, Thierry, Gracia, Gérard, Laroche, Cécile, Missiamenou, Viviane, Taylor, Charles, Konte, Marème, Andarala, Maryna, Fiorucci, Emanuela, Lefrancq, Elin Folkesson, Glémot, Myriam, McNeill, Patti Ann, Pommier, Caroline, Lafay, Myriam, Aquieri, A., Vega, H. Ruda, Blanco, M. Vázquez, Lust, K., Fagermo, N., Gabriel, H., Donhauser, E., Gasimov, Z., Jahangirov, T., Hasanova, I., De Backer, J., Demulier, L., de Hosson, M., Beckx, M., Moissens, M., Kovacevic-Preradovic, T., Kozic, M., Lovric, M., Freire, C. Vilas, Chilingirova, N., Kratunkov, P., Montesclaros, A. R., Beaubien, E., Gordon, E., Walter, L., Lindsay, C., Wahab, N., Vavera, Z., El Nagar, A., Ebaid, H. H., El Sayed Makled, W. A., Taha, N., Dardier, A., Shabaan, M., Elrakshy, Y., Eltamawey, K., Abd-El Aziz, M. Gamal, Saad, A., Aboleineen, W., Ashour, Z., Sorour, K., Mahdy, M. A.Meguid, Iserin, L., Ladouceur, M., Cohen, S., Iung, B., Maisuradze, D., Mebus, S., Gembruch, U., Hammerstingl, C., Merz, W. M., Wald, C., Motz, R., Olsson, A., Berger, F., Nagdyman, N., Frogoudaki, A., Anastasiou-Nana, M., Temesvari, A., Kohalmi, D., Balint, H., Merkely, B., Liptai, C., Bowen, M., Cullen, M., Thornton, P., Husarova, V., Blatt, A., Elbaz-Greener, G., Moravsky, G., Vered, Z., Fuhrmann, A. Vazan, Shotan, A., Goland, S., Festa, P., Ali, L. Ait, Sinagra, G., Puggia, I., Mottolese, B. D.Agata, Carmina, M. G., Romeo, C., Crepaz, R., Fesslova, V., Azzarelli, A., Baldi, D., Bovenzi, F., Donvito, V., Vasario, E., Todros, T., Niwa, K., Mussagaliyeva, A., Mekebekova, D., Sharipova, S., Zaliunas, R., Petrauskaite, J., Gumbiene, L., Jovanova, S., Cassar, A., Caruana, M., Karamermer, Y., Cornette, J. M.J., van Dijk, A., Bellersen, L., Duijnhouwer, T., De Groot, C., Pieper, E. P.G., van Oppen, C., Polak, P., Wajon, E., Wagenaar, L., Estensen, M., Lesniak-Sobelga, A., Podolec, P., Wisniowska-Smialek, S., Trybuch, A., Hoffman, P., Cichocka-Radwan, A., Lelonek, M., Sobczak, S., Faflik, U., Tomaszuk-Kazberuk, A., Przepiesc, J., Gil, M., Plaskota, K., Trojnarska, O., Guerra, N., de Sousa, L., Petrescu, V., Ginghina, C., Jurcut, R., Coman, I. Mircea, Gaisin, I. Ravilevich, Shilina, L. Valeryevna, Sharashkina, N., Tkacheva, O., Ivanov, D., Irtyuga, O., Jovovic, L., Prokselj, K., Kozelj, M., Elliott, C., Galian-Gay, L., Pijuan-Domenech, A., Subirana-Domenech, M. T., Tornos, P., Murga, N., Oliver, J. M., Escribano-Subías, P., Ruiz-Cano, M. J., Delgado-Jiménez, J., Furenas, E., Dellborg, M., Thilén, U., Schwerzmann, M., Bouchardy, J., Rutz, T., Sarac, L., Esen, O. Batukan, Enar, S. Catirli, Al Mulla, A., Bazargani, N., Al Hatou, E., Farook, F., Almahmeed, W., Salih, B., Clifford, P., Bowers, N., Veldtman, G., Kerr, J., Tellett, L., Hudsmith, L., Thompson, P., Thorne, S., Bowater, S., Nihoyannopoulos, P., Curry, R., Freeman, L., Schroeder, F., Wendler, R., Hammond, S., Talluto, C., Murphy, D., Perlroth, M. G., Chintala, K., Gupta, P., Pare, E., Khatri, N., Scott, N., De Faria-Yeh, D., Bhatt, A. B., Tsiaras, S., Gurvitz, M., Otto, C., Botti, J., Ting, J., and Davidson, W. R.

Abstract

Background Controversial results on maternal risk and fetal outcome have been reported in women with aortic stenosis (AS). Objectives The authors sought to investigate maternal and fetal outcomes in patients with AS in a large cohort. Methods The Registry on Pregnancy and Cardiac Disease (ROPAC) is a global, prospective observational registry of women with structural heart disease, providing a uniquely large study population. Data of women with moderate (peak gradient 36 to 63 mm Hg) and severe AS (peak gradient ≥64 mm Hg) were analyzed. Results Of 2,966 pregnancies in ROPAC, the authors identified 96 women who had at least moderate AS (34 with severe AS). No deaths were observed during pregnancy and in the first week after delivery. However, 20.8% of women were hospitalized for cardiac reasons during pregnancy. This was significantly more common in severe AS compared with moderate AS (35.3% vs. 12.9%; p = 0.02), and reached the highest rate (42.1%) in severe, symptomatic AS. Pregnancy was complicated by heart failure in 6.7% of asymptomatic and 26.3% of symptomatic patients, but could be managed medically, except for 1 patient who was symptomatic before pregnancy and underwent balloon valvotomy. Children of patients with severe AS had a significantly higher percentage of low birth weight (35.0% vs. 6.0%; p = 0.006). Conclusions Mortality in pregnant women with AS, including those with severe AS, appears to be close to zero in the current era. Symptomatic and severe AS does, however, carry a substantial risk of heart failure and is associated with high rates of hospitalization for cardiac reasons, although heart failure can nearly always be managed medically. The results highlight the importance of appropriate pre-conceptional patient evaluation and counseling.

Published
2016

14. Pregnancy in women with a mechanical heart valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC)

Author

Van Hagen, Iris M., Roos-Hesselink, Jolien W., Ruys, Titia P.E., Merz, Waltraut M., Goland, Sorel, Gabriel, Harald, Lelonek, Malgorzata, Trojnarska, Olga, Al Mahmeed, Wael Abdulrahman, Balint, Hajnalka Olga, Ashour, Zeinab, Baumgartner, Helmut, Boersma, Eric, Johnson, Mark R., Hall, Roger, Ferrari, Roberto, Maggioni, Aldo P., Marelli, Ariane, Webb, Gary, Kaemmerer, Harald, Popelova, Jana, Sliwa, Karen, Tavazzi, Luigi, Parsonage, William Anthony, Stein, Joerg, Elkayam, Uri, Thilen, Ulf, Budts, Werner, Vardas, Panos, Komajda, Michel, Pinto, Fausto, Alonso, Angeles, Wood, David, Maniadakis, Nikolaos, Ferreira, Thierry, Gracia, Gérard, Laroche, Cécile, Missiamenou, Viviane, Taylor, Charles, Konte, Marème, Andarala, Maryna, Fiorucci, Emanuela, Lefrancq, Elin Folkesson, Glémot, Myriam, McNeill, Patti Ann, Pommier, Caroline, Lafay, Myriam, Aquieri, A., Vega, H. Ruda, Blanco, M. Vázquez, Lust, K., Fagermo, N., Donhauser, E., Gasimov, Z., Jahangirov, T., Hasanova, I., De Backer, J., Demulier, L., de Hosson, M., Beckx, M., Moissens, M., Kovacevic-Preradovic, T., Kozic, M., Lovric, M., Freire, C. Vilas, Chilingirova, N., Kratunkov, P., Montesclaros, A. R., Beaubien, E., Gordon, E., Walter, L., Lindsay, C., Wahab, N., Vavera, Z., El Nagar, A. E., Ebaid, H. H., El Sayed Makled, W. A., Taha, N., Dardier, A., Shabaan, M., Elrakshy, Y., Eltamawey, K., Abd-El Aziz, M. Gamal, Saad, A., Aboleineen, W., Sorour, K., Mahdy, M. A.Meguid, Iserin, L., Ladouceur, M., Cohen, S., Iung, B., Maisuradze, D., Mebus, S., Gembruch, U., Hammerstingl, C., Wald, C., Orwat, S., Schmidt, R., Motz, R., Olsson, A., Berger, F., Nagdyman, N., Frogoudaki, A., Anastasiou-Nana, M., Temesvari, A., Kohalmi, D., Merkely, B., Liptai, C., Bowen, M., Cullen, M., Thornton, P., Husarova, V., Blatt, A., Elbaz-Greener, G., Moravsky, G., Vered, Z., Fuhrmann, A. Vazan, Shotan, A., Festa, P., Ali, L. Ait, Sinagra, G., Puggia, I., Mottolese, B. D.Agata, Carmina, M. G., Romeo, C., Crepaz, R., Fesslova, V., Azzarelli, A., Baldi, D., Bovenzi, F., Donvito, V., Vasario, E., Todros, T., Niwa, K., Mussagaliyeva, A., Mekebekova, D., Sharipova, S., Zaliunas, R., Jonkaitiene, R., Petrauskaite, J., Gumbiene, L., Jovanova, S., Cassar, A., Caruana, M., Karamermer, Y., Cornette, J. M.J., van Dijk, A., Bellersen, L., Duijnhouwer, T., De Groot, C., Pieper, E. P.G., van Oppen, C., Polak, P., Wajon, E., Wagenaar, L., Estensen, M., Lesniak-Sobelga, A., Podolec, P., Wisniowska-Smialek, S., Trybuch, A., Hoffman, P., Cichocka-Radwan, A., Sobczak, S., Faflik, U., Tomaszuk-Kazberuk, A., Przepiesc, J., Gil, M., Plaskota, K., Guerra, N., de Sousa, L., Petrescu, V., Ginghina, C., Jurcut, R., Coman, I. Mircea, Gaisin, I. Ravilevich, Shilina, L. Valeryevna, Sharashkina, N., Tkacheva, O., Ivanov, D., Irtyuga, O., Jovovic, L., Prokselj, K., Kozelj, M., Elliott, C., Galian-Gay, L., Pijuan-Domenech, A., Subirana-Domenech, M. T., Tornos, P., Murga, N., Oliver, J. M., Escribano-Subías, P., Ruiz-Cano, M. J., Delgado-Jiménez, J., Furenas, E., Dellborg, M., Thilén, U., Schwerzmann, M., Bouchardy, J., Rutz, T., Tobler, D., Sarac, L., Esen, O. B., Enar, S. C., Al Mulla, A., Bazargani, N., Al Hatou, E., Farook, F., Salih, B., Clifford, P., Bowers, N., Veldtman, G., Kerr, J., Tellett, L., Hudsmith, L., Thompson, P., Thorne, S., Bowater, S., Nihoyannopoulos, P., Curry, R., Freeman, L., Schroeder, F., Wendler, R., Hammond, S., Talluto, C., Murphy, D., Perlroth, M. G., Chintala, K., Gupta, P., Pare, E., Khatri, N., Scott, N., De Faria-Yeh, D., Bhatt, A. B., Tsiaras, S., Gurvitz, M., Otto, C., Botti, J., Ting, J., Davidson, W. R., Van Hagen, Iris M., Roos-Hesselink, Jolien W., Ruys, Titia P.E., Merz, Waltraut M., Goland, Sorel, Gabriel, Harald, Lelonek, Malgorzata, Trojnarska, Olga, Al Mahmeed, Wael Abdulrahman, Balint, Hajnalka Olga, Ashour, Zeinab, Baumgartner, Helmut, Boersma, Eric, Johnson, Mark R., Hall, Roger, Ferrari, Roberto, Maggioni, Aldo P., Marelli, Ariane, Webb, Gary, Kaemmerer, Harald, Popelova, Jana, Sliwa, Karen, Tavazzi, Luigi, Parsonage, William Anthony, Stein, Joerg, Elkayam, Uri, Thilen, Ulf, Budts, Werner, Vardas, Panos, Komajda, Michel, Pinto, Fausto, Alonso, Angeles, Wood, David, Maniadakis, Nikolaos, Ferreira, Thierry, Gracia, Gérard, Laroche, Cécile, Missiamenou, Viviane, Taylor, Charles, Konte, Marème, Andarala, Maryna, Fiorucci, Emanuela, Lefrancq, Elin Folkesson, Glémot, Myriam, McNeill, Patti Ann, Pommier, Caroline, Lafay, Myriam, Aquieri, A., Vega, H. Ruda, Blanco, M. Vázquez, Lust, K., Fagermo, N., Donhauser, E., Gasimov, Z., Jahangirov, T., Hasanova, I., De Backer, J., Demulier, L., de Hosson, M., Beckx, M., Moissens, M., Kovacevic-Preradovic, T., Kozic, M., Lovric, M., Freire, C. Vilas, Chilingirova, N., Kratunkov, P., Montesclaros, A. R., Beaubien, E., Gordon, E., Walter, L., Lindsay, C., Wahab, N., Vavera, Z., El Nagar, A. E., Ebaid, H. H., El Sayed Makled, W. A., Taha, N., Dardier, A., Shabaan, M., Elrakshy, Y., Eltamawey, K., Abd-El Aziz, M. Gamal, Saad, A., Aboleineen, W., Sorour, K., Mahdy, M. A.Meguid, Iserin, L., Ladouceur, M., Cohen, S., Iung, B., Maisuradze, D., Mebus, S., Gembruch, U., Hammerstingl, C., Wald, C., Orwat, S., Schmidt, R., Motz, R., Olsson, A., Berger, F., Nagdyman, N., Frogoudaki, A., Anastasiou-Nana, M., Temesvari, A., Kohalmi, D., Merkely, B., Liptai, C., Bowen, M., Cullen, M., Thornton, P., Husarova, V., Blatt, A., Elbaz-Greener, G., Moravsky, G., Vered, Z., Fuhrmann, A. Vazan, Shotan, A., Festa, P., Ali, L. Ait, Sinagra, G., Puggia, I., Mottolese, B. D.Agata, Carmina, M. G., Romeo, C., Crepaz, R., Fesslova, V., Azzarelli, A., Baldi, D., Bovenzi, F., Donvito, V., Vasario, E., Todros, T., Niwa, K., Mussagaliyeva, A., Mekebekova, D., Sharipova, S., Zaliunas, R., Jonkaitiene, R., Petrauskaite, J., Gumbiene, L., Jovanova, S., Cassar, A., Caruana, M., Karamermer, Y., Cornette, J. M.J., van Dijk, A., Bellersen, L., Duijnhouwer, T., De Groot, C., Pieper, E. P.G., van Oppen, C., Polak, P., Wajon, E., Wagenaar, L., Estensen, M., Lesniak-Sobelga, A., Podolec, P., Wisniowska-Smialek, S., Trybuch, A., Hoffman, P., Cichocka-Radwan, A., Sobczak, S., Faflik, U., Tomaszuk-Kazberuk, A., Przepiesc, J., Gil, M., Plaskota, K., Guerra, N., de Sousa, L., Petrescu, V., Ginghina, C., Jurcut, R., Coman, I. Mircea, Gaisin, I. Ravilevich, Shilina, L. Valeryevna, Sharashkina, N., Tkacheva, O., Ivanov, D., Irtyuga, O., Jovovic, L., Prokselj, K., Kozelj, M., Elliott, C., Galian-Gay, L., Pijuan-Domenech, A., Subirana-Domenech, M. T., Tornos, P., Murga, N., Oliver, J. M., Escribano-Subías, P., Ruiz-Cano, M. J., Delgado-Jiménez, J., Furenas, E., Dellborg, M., Thilén, U., Schwerzmann, M., Bouchardy, J., Rutz, T., Tobler, D., Sarac, L., Esen, O. B., Enar, S. C., Al Mulla, A., Bazargani, N., Al Hatou, E., Farook, F., Salih, B., Clifford, P., Bowers, N., Veldtman, G., Kerr, J., Tellett, L., Hudsmith, L., Thompson, P., Thorne, S., Bowater, S., Nihoyannopoulos, P., Curry, R., Freeman, L., Schroeder, F., Wendler, R., Hammond, S., Talluto, C., Murphy, D., Perlroth, M. G., Chintala, K., Gupta, P., Pare, E., Khatri, N., Scott, N., De Faria-Yeh, D., Bhatt, A. B., Tsiaras, S., Gurvitz, M., Otto, C., Botti, J., Ting, J., and Davidson, W. R.

Abstract

Background - Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event, and their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results - Within the prospective, observational, contemporary, worldwide Registry of Pregnancy and Cardiac disease (ROPAC), we describe the pregnancy outcome of 212 patients with an MHV. We compare them with 134 patients with a tissue heart valve and 2620 other patients without a prosthetic valve. Maternal mortality occurred in 1.4% of the patients with an MHV, in 1.5% of patients with a tissue heart valve (P=1.000), and in 0.2% of patients without a prosthetic valve (P=0.025). Mechanical valve thrombosis complicated pregnancy in 10 patients with an MHV (4.7%). In 5 of these patients, the valve thrombosis occurred in the first trimester, and all 5 patients had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of patients with an MHV, in 5.1% of patients with a tissue heart valve (P<0.001), and in 4.9% of patients without a prosthetic valve (P<0.001). Only 58% of the patients with an MHV had a pregnancy free of serious adverse events compared with 79% of patients with a tissue heart valve (P<0.001) and 78% of patients without a prosthetic valve (P<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%; P<0.001) and late fetal death (7.1% versus 0.7%; P=0.016). Conclusions - Women with an MHV have only a 58% chance of experiencing an uncomplicated pregnancy with a live birth. The markedly increased mortality and morbidity warrant extensive prepregnancy counseling and centralization of care.

Published
2015

Catalog

Books, media, physical & digital resources
See catalog results