P049 - SEX-RELATED DIFFERENCES AND THE INFLUENCE OF PREGNANCY ON CARDIAC OUTCOMES IN ADULTS WITH A SYSTEMIC RIGHT VENTRICLE AND BIVENTRICULAR PHYSIOLOGY

Thursday, October 27, 2022

4:55 PM – 5:05 PM EDT

Location: Room 201

Presenter(s)

Naïma-Ayane Mahdi, n/a (she/her/hers)

Resident Internal Medicine
Université de Montréal
n/a
Montréal, Quebec, Canada

First Author(s)

Naïma-Ayane Mahdi, n/a (she/her/hers)

Resident Internal Medicine
Université de Montréal
n/a
Montréal, Quebec, Canada

Senior Author(s)

Marie-A. Chaix

ACHD and echocardiography cardiologist
Montreal Heart Institute
Université de Montréal
Montréal, Quebec, Canada

Supervisor(s)

Marie-A. Chaix

ACHD and echocardiography cardiologist
Montreal Heart Institute
Université de Montréal
Montréal, Quebec, Canada

Author(s)

LG

Léa Guerma, n/a

Montréal, Quebec, Canada
AD

Annie Dore

ACHD and echocardiography cardiologist
Montreal, Quebec, Canada
Blandine Mondésert, MD

MD
Montreal Heart Institute
MD
Montréal, Quebec, Canada
Line Leduc, MD FRCSC, DABOG(MFM)

Obstetrician-Gynecologist
Université de Montréal/ CHU Sainte-Justine
Université de Montréal
Montréal, Quebec, Canada
EC

Elisabeth Codsi

Obstetrician-Gynecologist
UdeM
Montréal, Quebec, Canada
Paul Khairy, MD, PhD, MHI

ACHD and electrophysiology cardiologist
Montreal Heart Institute
Montréal, Quebec, Canada
FM

François-Pierre Mongeon

ACHD and echocardiography cardiologist
Montréal, Quebec, Canada

Background: Transposition of the great arteries (TGA) with a systemic right ventricle (sRV) and biventricular physiology is associated with increased morbidity and mortality. There is a paucity of data regarding sex-related differences in outcomes in the context of a sRV. Moreover, pregnancy has been associated with deterioration of sRV function in short-term post-partum follow-up, but the long-term impact remains largely unknown.

METHODS AND RESULTS: A retrospective cohort study was conducted on 214 adults, age 44.7±12.3 years, with a sRV and biventricular physiology followed for a median of 13 years at an adult congenital heart disease center. No sex-related difference was identified in the prevalence of atrial or ventricular arrhythmias, permanent pacemaker implantation, hospitalization for heart failure, systemic atrio-ventricular valve intervention, heart transplant, or cardiac death. Among the 82 (38.3%) women, age 44.0±12.5 years, 43 (52.4%) had at least one full-term pregnancy. Women had a lower prevalence of moderate to severe sRV dysfunction than men (21% vs 42.6%, p=0.001) despite similar ages. Beta-blockers (p=0.008), furosemide (p=0.012), and mineralocorticoid receptor antagonists (p=0.028) were less frequently prescribed to women than men. Women had fewer implantable cardioverter-defibrillators (ICDs) for primary prevention than men (3.7% vs 13.6%, p=0.016), with no difference in the prevalence of secondary prevention ICDs (1.2% vs 2.3%, p=1). The four women with a prohibitive maternal mortality risk (modified WHO class IV) complied with recommendations to avoid pregnancy. After excluding these 4 women, no differences regarding frequency of adverse cardiac events, age at the time of event, and proportion with moderate or severe sRV dysfunction were observed in women with (N=43) and without (N=35) pregnancies during 14 years of follow-up.

Conclusion: Women with TGA and a sRV had a lower prevalence of moderate to severe systemic ventricular dysfunction than men, along with a lower proportion of primary prevention ICDs. Following risk assessment and counselling with contraindication of pregnancy in the highest risk subgroup, pregnancy had no impact on long-term cardiac outcomes. Further mechanistic studies are required to elucidate sex-related differences, including the influence of hormonal factors on sRV function.