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Heart Disease in Women
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Heart Disease in Women

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425).

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 48235

Special Issue Editors

Prof. Dr. Cynthia C. Taub

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Guest Editor
Department of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
Interests: heart disease in women; cardiac imaging
Special Issues, Collections and Topics in MDPI journals
Dr. Anna E. Bortnick

E-Mail Website
Guest Editor
Cardiology, Montefiore Medical Center, Bronx, NY 10461, USA
Interests: heart disease in women; interventional cardiology
Special Issues, Collections and Topics in MDPI journals
Dr. Diana S. Wolfe

E-Mail Website
Guest Editor
MFM, OB GYN, Montefiore Medical Center, Bronx, NY 10461, USA
Interests: high-risk pregnancy; heart disease in women
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There has been an increase in the maternal death rate in the US in recent years. This is greatly driven by cardiovascular disease-related deaths. Cardiovascular disease accounted for 15.5% of maternal deaths in the United States between 2011 and 2013. There are several contributing factors, including the increasing number of women with congenital heart disease reaching reproductive age and a higher prevalence of chronic medical conditions that put women at risk for cardiac complications. Cardio-obstetrics is an evolving interdisciplinary field that allows experts from different specialties to work together and create new models to take care of patients before, during, and after pregnancy. There are numerous knowledge gaps in our understanding of heart disease in women, during their childbearing periods, and importantly beyond their reproductive years. We call for research studies to explore epidemiologic trends of women's heart disease in the world, innovative diagnostic tools and algorithms to address complex clinical dilemmas, solutions for multidisciplinary team building, patient-centered education and decision making, and many more topics related to heart disease in women. The goal of this Special Issue is to establish a forum for obstetricians and gynecologists, cardiac imagers, cardiac interventionalists, electrophysiologists, congenital heart specialists, surgeons, clinical fellows, and others to contribute to our understanding of heart disease in women.

Prof. Dr. Cynthia C. Taub
Dr. Anna E. Bortnick
Dr. Diana S. Wolfe
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • imaging in women
  • peripartum cardiomyopathy
  • adult congenital heart disease in pregnancy
  • POCUS
  • labor and delivery

Published Papers (17 papers)

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Editorial

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4 pages, 220 KiB  
Editorial
Women’s Cardiovascular Health: Prioritizing the Majority Minority
by Anna E. Bortnick, Edita Pllana, Diana S. Wolfe and Cynthia C. Taub
J. Cardiovasc. Dev. Dis. 2023, 10(3), 128; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10030128 - 17 Mar 2023
Viewed by 1050
Abstract
Women make up the majority of the global population, and [...] Full article
(This article belongs to the Special Issue Heart Disease in Women)

Research

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11 pages, 762 KiB  
Article
Association between Abnormal Echocardiography and Adverse Obstetric Outcomes in Low-Risk Pregnant Women
by Kerrilynn C. Hennessey, Thara S. Ali, Eunjung Choi, Alexandra R. Ortengren, Leigh C. Hickerson, Jennifer May Lee and Cynthia C. Taub
J. Cardiovasc. Dev. Dis. 2022, 9(11), 394; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9110394 - 15 Nov 2022
Cited by 2 | Viewed by 1739
Abstract
Maternal mortality in the United States is a public health crisis of preventable deaths among young women. The role of echocardiography in the evaluation of pregnant women with cardiovascular symptoms or risk factors without known heart disease is unclear. We retrospectively examined the [...] Read more.
Maternal mortality in the United States is a public health crisis of preventable deaths among young women. The role of echocardiography in the evaluation of pregnant women with cardiovascular symptoms or risk factors without known heart disease is unclear. We retrospectively examined the clinical characteristics of consecutive pregnant patients without established heart disease who underwent echocardiography and evaluated associations between abnormal exam findings and obstetric outcomes. Among low-risk women undergoing echocardiography during pregnancy, older age, higher parity and a history of chronic hypertension are associated with a higher likelihood of echocardiographic abnormalities, which in turn are associated with a higher likelihood of adverse obstetric outcomes including caesarean section and preterm delivery. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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10 pages, 392 KiB  
Article
Chronic Thromboembolic Pulmonary Hypertension in Females: Clinical Features and Survival
by Yan Wu, Song Hu, Xin-Xin Yan, Fu-Hua Peng, Jiang-Shan Tan, Ting-Ting Guo, Xin Gao and Lu Hua
J. Cardiovasc. Dev. Dis. 2022, 9(9), 308; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9090308 - 16 Sep 2022
Cited by 1 | Viewed by 1604
Abstract
Sparse data are available on the female-specific features of chronic thromboembolic pulmonary hypertension (CTEPH). We prospectively enrolled 160 consecutive female patients who were firstly diagnosed with CTEPH between 2013 and 2019 to explore their clinical phenotypes, treatment patterns, and long-term survival. The patients’ [...] Read more.
Sparse data are available on the female-specific features of chronic thromboembolic pulmonary hypertension (CTEPH). We prospectively enrolled 160 consecutive female patients who were firstly diagnosed with CTEPH between 2013 and 2019 to explore their clinical phenotypes, treatment patterns, and long-term survival. The patients’ mean age was 54.7 ± 13.8 years, 70.6% provided a confirmed history of venous thromboembolism, 46 (28.8%) patients underwent pulmonary endarterectomy (PEA), 65 (40.6%) received balloon pulmonary angioplasty (BPA), and 49 (30.6%) were treated with medical therapy alone. The patients were followed for a median of 51 (34–70) months; three patients were lost to follow-up, and twenty-two patients died. The estimated survival rates at 1, 3, 5, and 7 years were 98.1% (95% CI 96.0–100), 96.9% (95% CI 94.2–99.6), 85.1% (95% CI 78.1–92.2), and 76.2% (95% CI 65.2–87.2), respectively. After adjusting for the confounders, the results of the multivariate Cox analysis showed that the presence of anemia (5.56, 95% CI 1.6–19.22) was associated with an increased risk of all-cause death, and compared with medical treatment, receiving PEA and BPA decreased the risk of death by 74% (0.26, 95% CI 0.07–0.97) and 86% (0.14, 95% CI 0.04–0.57), respectively. In conclusion, in the modern era of CTEPH treatment, invasive revascularization combined with targeted therapy display good clinical outcomes for females; anemia should be actively modified, which may lead to clinical improvements. (ClinicalTrials.gov Identifier: NCT05360992). Full article
(This article belongs to the Special Issue Heart Disease in Women)
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11 pages, 543 KiB  
Article
Maternal Outcomes in Women with Peripartum Cardiomyopathy versus Age and Race-Matched Peers in an Urban US Community
by Diana S. Wolfe, Christina Liu, Jack Alboucai, Ariel Karten, Juliet Mushi, Shira Yellin, Julia L. Berkowitz, Shayna Vega, Nicole Felix, Wasla Liaqat, Rohan Kankaria, Thammatat Vorawandthanachai and Anna E. Bortnick
J. Cardiovasc. Dev. Dis. 2022, 9(8), 250; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9080250 - 06 Aug 2022
Cited by 3 | Viewed by 2120
Abstract
Peripartum cardiomyopathy (PPCM) is idiopathic systolic congestive heart failure around pregnancy. Comparisons with matched controls are lacking. We investigated maternal characteristics and outcomes up to 12 months in a cohort admitted to Montefiore Health System in Bronx, New York 1999–2015 (n = [...] Read more.
Peripartum cardiomyopathy (PPCM) is idiopathic systolic congestive heart failure around pregnancy. Comparisons with matched controls are lacking. We investigated maternal characteristics and outcomes up to 12 months in a cohort admitted to Montefiore Health System in Bronx, New York 1999–2015 (n = 53 cases and n = 92 age and race-matched controls, >80% Black or Hispanic/Latina). Compared to peers, women with PPCM had more chronic hypertension (24.5% vs. 8.8%, p = 0.001), prior gestational hypertension (20.8% vs. 5.4%, p = 0.001), prior preeclampsia (17.0% vs. 3.3%, p = 0.001), familial dilated cardiomyopathy (5.7% vs. 0.0%, p = 0.04), smoking (15.1% vs. 2.2%, p = 0.001), lower summary socioeconomic scores (−4.12 (IQR −6.81, −2.13) vs. −1.62 (IQR −4.20, −0.74), p < 0.001), public insurance (67.9% vs. 29.3% p = 0.001), and frequent depressive symptoms. Women with PPCM were often admitted antepartum (34.0% vs. 18.5%, p = 0.001) and underwent Cesarean section (65.4% vs. 30.4%, p = 0.001), but had less preterm labor (27.3% vs. 51.1%, p = 0.001). Women were rarely treated with bromocriptine (3.8%), frequently underwent left ventricular assist device placement (9.4% and n = 2 with menorrhagia requiring transfusion and progesterone) or heart transplantation (3.8%), but there were no in-hospital deaths. In sum, women with PPCM had worse socioeconomic disadvantage and baseline health than matched peers. Programs addressing social determinants of health may be important for women at high risk of PPCM. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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16 pages, 885 KiB  
Article
Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center
by Anjali Vaidya, Estefania Oliveros, Wadia Mulla, Diana Feinstein, Laura Hart and Paul Forfia
J. Cardiovasc. Dev. Dis. 2022, 9(6), 195; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060195 - 18 Jun 2022
Cited by 5 | Viewed by 3735
Abstract
(1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmonary hypertension [...] Read more.
(1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmonary hypertension (PH) center from 2013 to 2021. (3) Results: seven pregnancies in six women with PAH, ranging from low to high risk and 21 to 37 years old. Half had known pre-existing PAH before pregnancy. One had a multifetal gestation, and one was pregnant twice under our care. PH medical therapy and serial clinical assessment throughout pregnancy were implemented with focused attention on optimizing right heart function. Delivery was planned by a multidisciplinary team involving PH cardiology, maternal fetal medicine, and obstetric anesthesiology. Patients delivered between 31 and 40 weeks of gestation; five of the seven were via cesarean section. All received regional anesthesia and were monitored in the PH intermediate step-down unit after delivery until discharge. In all cases, delivery was without complications with excellent outcomes for the mother and child. (4) Conclusions: Multidisciplinary and tailored management of PAH in pregnancy, emphasizing optimized right heart function prior to delivery, can result in excellent clinical outcomes in a referral PH center. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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12 pages, 795 KiB  
Article
Maternal Glycemic Spectrum and Adverse Pregnancy and Perinatal Outcomes in a Multiracial US Cohort
by Yaa Adoma Kwapong, Ellen Boakye, Guoying Wang, Xiumei Hong, Jennifer Lewey, Mamas Andreas Mamas, Pensee Wu, Michael Joseph Blaha, Khurram Nasir, Allison Gamboa Hays, Roger Scott Blumenthal, Xiaobin Wang and Garima Sharma
J. Cardiovasc. Dev. Dis. 2022, 9(6), 179; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060179 - 04 Jun 2022
Cited by 4 | Viewed by 2353
Abstract
Diabetes mellitus (pregestational (PDM) and gestational (GDM)) is associated with adverse pregnancy outcomes (APOs). However, studies exploring the association of APOs with maternal glycemia among women without PDM/GDM are limited. We utilized data from 4119 women (307—PDM; 582—GDM; 3230—non-PDM/GDM) in the Boston Birth [...] Read more.
Diabetes mellitus (pregestational (PDM) and gestational (GDM)) is associated with adverse pregnancy outcomes (APOs). However, studies exploring the association of APOs with maternal glycemia among women without PDM/GDM are limited. We utilized data from 4119 women (307—PDM; 582—GDM; 3230—non-PDM/GDM) in the Boston Birth Cohort (1998–2016). Women in the non-PDM/GDM group were subdivided by tertiles of 1 h, 50 g oral glucose load test at 24–32 weeks: T1: 50–95 mg/dL (n = 1166), T2: 96–116 mg/dL (n = 1151), T3: 117–201 mg/dL (n = 913). Using multivariable logistic regression, we examined the association of maternal glycemia with APOs—preterm birth (PTB) and hypertensive disorders of pregnancy (HDP)—and adverse perinatal outcomes—high birth weight (HBW), cesarean section (CS), and sub-analyses by race-ethnicity. Compared to women in T1, women in T2 and T3 had a higher prevalence of pre-existing hypertension (T1: 2.8% vs. T2: 5.2% vs. T3: 6.3%) and obesity (T1: 13.3% vs. T2: 18.1% vs. T3: 22.9%). Women in T2 and T3 had higher odds of HBW (adjusted odds ratio aOR T2: 1.47 [1.01–2.19] T3: 1.68 [1.13–2.50]) compared to women in T1. Additionally, women in T2, compared to T1, had higher odds of HDP (aOR 1.44 [1.10–1.88]). Among non-Hispanic Black (NHB) women, those in T2 and T3 had higher odds of HDP compared to T1 (aOR T2 1.67 [1.13–2.51]; T3: 1.68 [1.07–2.62]). GDM and PDM were associated with higher odds of HBW, CS, PTB, and HDP, compared to women in T1. In this predominantly NHB and Hispanic cohort, moderate maternal glycemia without PDM/GDM was associated with higher odds of HBW and HDP, even more strongly among NHB women. If confirmed, a review of current guidelines of glucose screening and risk stratification in pregnancy may be warranted. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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Graphical abstract

10 pages, 295 KiB  
Article
Gender Particularities and Prevalence of Atypical Clinical Presentation in Non-ST Elevation Acute Coronary Syndrome
by Mihai Octavian Negrea, Dumitru Zdrenghea, Minodora Teodoru, Bogdan Neamțu, Călin Remus Cipăian and Dana Pop
J. Cardiovasc. Dev. Dis. 2022, 9(3), 84; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9030084 - 14 Mar 2022
Cited by 3 | Viewed by 2457
Abstract
Clinical presentation is one of the factors that can influence how quickly a patient with an acute coronary syndrome is treated, particularly if it is atypical. The purposes of this study are to explore gender-related differences in patients presenting with non-ST elevation acute [...] Read more.
Clinical presentation is one of the factors that can influence how quickly a patient with an acute coronary syndrome is treated, particularly if it is atypical. The purposes of this study are to explore gender-related differences in patients presenting with non-ST elevation acute coronary syndromes (NSTEACS) from the perspective of a series of common risk factors as well as treatment strategies and to evaluate the prevalence of atypical clinical presentation of NSTEACS in the study group. In addition, we explored the differences between the two entities that define NSTEACS: unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). We conducted a retrospective study by reviewing discharge documents of patients admitted in the cardiology department of the Clinical Rehabilitation Hospital in Cluj-Napoca with NSTEACS between January 2014 and December 2015. We retrieved demographic data, clinical presentation and history, laboratory tests, and coronary angiography records as well as the implemented treatment strategies. Women in the study group were more frequently hypertensive than men (89.5% vs. 75.4%; p = 0.043), had a higher mean serum HDL cholesterol value (43 vs. 38 mg/dL p = 0.022), were more frequently diagnosed with microvascular coronary heart disease (32% vs. 9.8%, p = 0.036), and were more often treated conservatively (49.1% vs. 30.8%, p = 0.038), while men were significantly more prone to smoking than women (30.8% vs. 14%, p = 0.028) and had higher mean serum creatinine (1.2 vs. 0.8 mg/dL; p = 0.022) and uric acid values (6.9 vs. 6.2 mg/dL; p = 0.048). Out of the 122 included patients, 109 had documented information regarding symptoms. The prevalence of atypical presentation was 4.6% (95% CI 0.7–8.5%). In our study group, patients with UA had a more frequent history of cardiovascular ischemic diseases (77.4% vs. 56.7%, p = 0.015), the mean value for BUN was higher in NSTEMI patients compared to patients with UA (47 vs. 39 mg/dL, p = 0.038) and NSTEMI patients more frequently received interventional treatment compared to patients with UA (60% vs. 41.9%; p = 0.046). Full article
(This article belongs to the Special Issue Heart Disease in Women)

Review

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15 pages, 903 KiB  
Review
Maternal Cardiovascular Outcomes of Pregnancy in Childhood, Adolescent, and Young Adult Cancer Survivors
by Neha Bansal, Carol Fernandez Hazim, Sergio Badillo, Sharvari Shyam, Diana Wolfe, Anna E. Bortnick, Mario J. Garcia, Carols J. Rodriguez and Lili Zhang
J. Cardiovasc. Dev. Dis. 2022, 9(11), 373; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9110373 - 31 Oct 2022
Cited by 1 | Viewed by 1623
Abstract
This review focuses on the maternal cardiovascular risk and outcomes of pregnancy in childhood, adolescent, and young adult cancer survivors who are achieving survival to their prime reproductive years. Childhood, adolescent, and young adult cancer survivors are a growing population and have increasing [...] Read more.
This review focuses on the maternal cardiovascular risk and outcomes of pregnancy in childhood, adolescent, and young adult cancer survivors who are achieving survival to their prime reproductive years. Childhood, adolescent, and young adult cancer survivors are a growing population and have increasing needs for reproductive care over decades of life. Female cancer survivors have an overall higher risk of maternal cardiovascular events compared to those without a history of cancer. In female cancer survivors with normal cardiac function before pregnancy, the incidence of new heart failure during pregnancy is low. In survivors with cardiotoxicity prior to pregnancy, the risk of heart failure during and immediately after pregnancy is much higher. We recommend cardiomyopathy surveillance with echocardiography before pregnancy for all female survivors treated with anthracyclines and chest radiation. Survivors with cardiotoxicity prior to pregnancy should be cared for by an expert multidisciplinary team, including obstetrics, cardiology, anesthesia, and specialized nursing, among others. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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20 pages, 1471 KiB  
Review
Sex Differences in Acute Coronary Syndromes: A Global Perspective
by F Aaysha Cader, Shrilla Banerjee and Martha Gulati
J. Cardiovasc. Dev. Dis. 2022, 9(8), 239; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9080239 - 27 Jul 2022
Cited by 19 | Viewed by 5620
Abstract
Despite increasing evidence and improvements in the care of acute coronary syndromes (ACS), sex disparities in presentation, comorbidities, access to care and invasive therapies remain, even in the most developed countries. Much of the currently available data are derived from more developed regions [...] Read more.
Despite increasing evidence and improvements in the care of acute coronary syndromes (ACS), sex disparities in presentation, comorbidities, access to care and invasive therapies remain, even in the most developed countries. Much of the currently available data are derived from more developed regions of the world, particularly Europe and the Americas. In contrast, in more resource-constrained settings, especially in Sub-Saharan Africa and some parts of Asia, more data are needed to identify the prevalence of sex disparities in ACS, as well as factors responsible for these disparities, particularly cultural, socioeconomic, educational and psychosocial. This review summarizes the available evidence of sex differences in ACS, including risk factors, pathophysiology and biases in care from a global perspective, with a focus on each of the six different World Health Organization (WHO) regions of the world. Regional trends and disparities, gaps in evidence and solutions to mitigate these disparities are also discussed. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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16 pages, 667 KiB  
Review
Arrhythmias and Heart Failure in Pregnancy: A Dialogue on Multidisciplinary Collaboration
by Kamala P. Tamirisa, Cicely Dye, Rachel M. Bond, Lisa M. Hollier, Karolina Marinescu, Marmar Vaseghi, Andrea M. Russo, Martha Gulati and Annabelle Santos Volgman
J. Cardiovasc. Dev. Dis. 2022, 9(7), 199; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9070199 - 24 Jun 2022
Cited by 4 | Viewed by 3918
Abstract
The prevalence of CVD in pregnant people is estimated to be around 1 to 4%, and it is imperative that clinicians that care for obstetric patients can promptly and accurately diagnose and manage common cardiovascular conditions as well as understand when to promptly [...] Read more.
The prevalence of CVD in pregnant people is estimated to be around 1 to 4%, and it is imperative that clinicians that care for obstetric patients can promptly and accurately diagnose and manage common cardiovascular conditions as well as understand when to promptly refer to a high-risk obstetrics team for a multidisciplinary approach for managing more complex patients. In pregnant patients with CVD, arrhythmias and heart failure (HF) are the most common complications that arise. The difficulty in the management of these patients arises from variable degrees of severity of both arrhythmia and heart failure presentation. For example, arrhythmia-based complications in pregnancy can range from isolated premature ventricular contractions to life-threatening arrhythmias such as sustained ventricular tachycardia. HF also has variable manifestations in pregnant patients ranging from mild left ventricular impairment to patients with advanced heart failure with acute decompensated HF. In high-risk patients, a collaboration between the general obstetrics, maternal-fetal medicine, and cardiovascular teams (which may include cardio-obstetrics, electrophysiology, adult congenital, or advanced HF)—physicians, nurses and allied professionals—can provide the multidisciplinary approach necessary to properly risk-stratify these women and provide appropriate management to improve outcomes. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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11 pages, 1046 KiB  
Review
Acute Coronary Syndrome in Pregnancy and the Post-Partum Period
by Anna C. O’Kelly, Jonathan Ludmir and Malissa J. Wood
J. Cardiovasc. Dev. Dis. 2022, 9(7), 198; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9070198 - 23 Jun 2022
Cited by 7 | Viewed by 2968
Abstract
Cardiovascular disease is the leading cause of maternal mortality in the United States. Acute coronary syndrome (ACS) is more common in pregnant women than in non-pregnant controls and contributes to the burden of maternal mortality. This review highlights numerous etiologies of chest discomfort [...] Read more.
Cardiovascular disease is the leading cause of maternal mortality in the United States. Acute coronary syndrome (ACS) is more common in pregnant women than in non-pregnant controls and contributes to the burden of maternal mortality. This review highlights numerous etiologies of chest discomfort during pregnancy, as well as risk factors and causes of ACS during pregnancy. It focuses on the evaluation and management of ACS during pregnancy and the post-partum period, including considerations when deciding between invasive and non-invasive ischemic evaluations. It also focuses specifically on the management of post-myocardial infarction complications, including shock, and outlines the role of mechanical circulatory support, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Finally, it offers additional recommendations for navigating delivery in women who experienced pregnancy-associated myocardial infarction and considerations for the post-partum patient who develops ACS. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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12 pages, 505 KiB  
Review
Pregnancy in Pulmonary Arterial Hypertension: A Multidisciplinary Approach
by Yasmeen Daraz, Sandhya Murthy and Diana Wolfe
J. Cardiovasc. Dev. Dis. 2022, 9(6), 196; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060196 - 18 Jun 2022
Cited by 6 | Viewed by 2110
Abstract
Pulmonary arterial hypertension (PAH), a female predominant disease, carries a high maternal and fetal mortality in pregnancy despite improved insight and the development of novel therapies. The high risk is attributed to the adaptive changes that take place to promote healthy fetal development [...] Read more.
Pulmonary arterial hypertension (PAH), a female predominant disease, carries a high maternal and fetal mortality in pregnancy despite improved insight and the development of novel therapies. The high risk is attributed to the adaptive changes that take place to promote healthy fetal development during pregnancy, which can adversely affect the already compromised right ventricle in patients with PAH. While in the prior era emphasis was placed on termination of pregnancy, here we will illustrate through a multidisciplinary approach and meticulous planning at an expert center, these high-risk women can undergo successful childbirth. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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9 pages, 1857 KiB  
Review
Screening for Cardiovascular Disease in Pregnancy: Is There a Need?
by Melissa E. Chambers, Madushka Y. De Zoysa and Afshan B. Hameed
J. Cardiovasc. Dev. Dis. 2022, 9(3), 89; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9030089 - 17 Mar 2022
Cited by 7 | Viewed by 3201
Abstract
Maternal mortality in the United States has been on the rise. Every year, about 700 women die from pregnancy-related complications. Cardiovascular disease (CVD) accounts for a large majority of pregnancy-related deaths driven by the lack of recognition and delays in diagnosis due to [...] Read more.
Maternal mortality in the United States has been on the rise. Every year, about 700 women die from pregnancy-related complications. Cardiovascular disease (CVD) accounts for a large majority of pregnancy-related deaths driven by the lack of recognition and delays in diagnosis due to the overlap of normal pregnancy symptoms with those of CVD. Risk factors for CVD including race, advanced maternal age, hypertension, diabetes, obesity, socioeconomic status, and geographic region play an important role in CVD-related deaths. Several risk assessment models are available to stratify women with a known diagnosis of CVD. However, most women who die from CVD during pregnancy or the postpartum period do not have a prior diagnosis of CVD, and cardiomyopathy is an important contributor. The California Maternal Quality Care Collaborative (CMQCC) developed an algorithm to screen all pregnant and postpartum women to allow stratification into low or high risk for CVD. The algorithm has been validated in diverse patient populations. We propose universal CVD screening for all women in the antepartum and postpartum period to identify women at risk and to provide education and awareness for both patients and healthcare providers. This screening tool would work to reduce the increasing rates of severe maternal mortality and morbidity while having a significant impact on healthcare costs in the United States. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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18 pages, 329 KiB  
Review
Optimising Cardiometabolic Risk Factors in Pregnancy: A Review of Risk Prediction Models Targeting Gestational Diabetes and Hypertensive Disorders
by Eleanor P. Thong, Drishti P. Ghelani, Pamada Manoleehakul, Anika Yesmin, Kaylee Slater, Rachael Taylor, Clare Collins, Melinda Hutchesson, Siew S. Lim, Helena J. Teede, Cheryce L. Harrison, Lisa Moran and Joanne Enticott
J. Cardiovasc. Dev. Dis. 2022, 9(2), 55; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9020055 - 10 Feb 2022
Cited by 6 | Viewed by 3253
Abstract
Cardiovascular disease, especially coronary heart disease and cerebrovascular disease, is a leading cause of mortality and morbidity in women globally. The development of cardiometabolic conditions in pregnancy, such as gestational diabetes mellitus and hypertensive disorders of pregnancy, portend an increased risk of future [...] Read more.
Cardiovascular disease, especially coronary heart disease and cerebrovascular disease, is a leading cause of mortality and morbidity in women globally. The development of cardiometabolic conditions in pregnancy, such as gestational diabetes mellitus and hypertensive disorders of pregnancy, portend an increased risk of future cardiovascular disease in women. Pregnancy therefore represents a unique opportunity to detect and manage risk factors, prior to the development of cardiovascular sequelae. Risk prediction models for gestational diabetes mellitus and hypertensive disorders of pregnancy can help identify at-risk women in early pregnancy, allowing timely intervention to mitigate both short- and long-term adverse outcomes. In this narrative review, we outline the shared pathophysiological pathways for gestational diabetes mellitus and hypertensive disorders of pregnancy, summarise contemporary risk prediction models and candidate predictors for these conditions, and discuss the utility of these models in clinical application. Full article
(This article belongs to the Special Issue Heart Disease in Women)

Other

16 pages, 963 KiB  
Systematic Review
Pulmonary Embolism in Women: A Systematic Review of the Current Literature
by Rosy Thachil, Sanjana Nagraj, Amrin Kharawala and Seth I. Sokol
J. Cardiovasc. Dev. Dis. 2022, 9(8), 234; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9080234 - 25 Jul 2022
Cited by 4 | Viewed by 4094
Abstract
Cardiovascular disease is the leading cause of death in women. Pulmonary embolism (PE) is the third most-common cause of cardiovascular death, after myocardial infarction (MI) and stroke. We aimed to evaluate the attributes and outcomes of PE specifically in women and explore sex-based [...] Read more.
Cardiovascular disease is the leading cause of death in women. Pulmonary embolism (PE) is the third most-common cause of cardiovascular death, after myocardial infarction (MI) and stroke. We aimed to evaluate the attributes and outcomes of PE specifically in women and explore sex-based differences. We conducted a systematic review of the literature using electronic databases PubMed and Embase up to 1 April 2022 to identify studies investigating PE in women. Of the studies found, 93 studies met the eligibility criteria and were included. The risk of PE in older women (especially >40 years of age) superseded that of age-matched men, although the overall age- and sex-adjusted incidence of PE was found to be lower in women. Risk factors for PE in women included age, rheumatologic disorders, hormone replacement therapy or oral contraceptive pills, pregnancy and postpartum period, recent surgery, immobilization, trauma, increased body mass index, obesity, and heart failure. Regarding pregnancy, a relatively higher incidence of PE has been observed in the immediate postpartum period compared to the antenatal period. Women with PE tended to be older, presented more often with dyspnea, and were found to have higher NT-proBNP levels compared to men. No sex-based differences in in-hospital mortality and 30-day all-cause mortality were found. However, PE-related mortality was higher in women, particularly in hemodynamically stable patients. These differences form the basis of future research and outlets for reducing the incidence, morbidity, and mortality of PE in women. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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8 pages, 6468 KiB  
Commentary
The Utility of Maternal Point of Care Ultrasound on Labor and Delivery Wards
by Mohammed Algodi, Diana S. Wolfe and Cynthia C. Taub
J. Cardiovasc. Dev. Dis. 2022, 9(1), 29; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9010029 - 14 Jan 2022
Cited by 2 | Viewed by 2579
Abstract
Point-of-care ultrasonography (POCUS) refers to limited bedside ultrasound used to evaluate patients for conditions specific to the scope of their practice. Given the benefits of its application, interest in its use is increasing. We aimed to review the literature and assess the potential [...] Read more.
Point-of-care ultrasonography (POCUS) refers to limited bedside ultrasound used to evaluate patients for conditions specific to the scope of their practice. Given the benefits of its application, interest in its use is increasing. We aimed to review the literature and assess the potential feasibility of using POCUS of the heart and lungs in the field of obstetrics. We aim to describe its relevance and value as an adjunctive tool for critically ill obstetric patients on labor and delivery wards. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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5 pages, 2822 KiB  
Case Report
Unique Case of Spontaneous Left Main Coronary Dissection in Second Trimester of Pregnancy Successfully Treated with Percutaneous Coronary Intervention: A Happy Ending
by Francesca Mantovani, Alessandro Navazio, Giovanni Tortorella and Vincenzo Guiducci
J. Cardiovasc. Dev. Dis. 2022, 9(1), 9; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9010009 - 31 Dec 2021
Cited by 3 | Viewed by 1599
Abstract
Among pregnant women, SCAD is the most frequent etiology of non-atherosclerotic acute coronary syndrome. SCAD related to pregnancy is more frequent within the first month (especially first week) of puerperium or last trimester, or is otherwise anecdotal. The concomitance of SCAD and pregnancy [...] Read more.
Among pregnant women, SCAD is the most frequent etiology of non-atherosclerotic acute coronary syndrome. SCAD related to pregnancy is more frequent within the first month (especially first week) of puerperium or last trimester, or is otherwise anecdotal. The concomitance of SCAD and pregnancy poses many issues regarding diagnosis and treatment in respect to maternal and fetal safety and requires tailored intervention with close interaction between clinical cardiologists, interventional cardiologists, cardiothoracic surgeons, and obstetricians. We report the case of a patient, pregnant in the second trimester with a life-threatening SCAD, successfully treated with percutaneous coronary intervention with excellent outcome for mother and baby. Full article
(This article belongs to the Special Issue Heart Disease in Women)
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