(991) Abnormal Electrocardiogram or Echocardiogram as Interim Measures for CVD Risk Stratification in Pregnancy and Postpartum

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective:

Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States. The diagnosis of CVD is challenging as signs and symptoms of normal pregnancy may mimic CVD. The California Maternal Quality Care Collaborative (CMQCC) CVD risk assessment algorithm was used to help stratify pregnant and postpartum patients into low or high risk for CVD and guide further cardiac testing. We sought to evaluate the intermediate outcomes, i.e., abnormal electrocardiogram (EKG) and echocardiogram, as surrogates for CVD to assess the positive predictive value of the CMQCC tool in patients determined to be at high risk for CVD.

Study Design:

Retrospective medical record review of 1,399 patients that underwent CVD risk stratification using the CMQCC algorithm over an 18-month period at a major hospital network in California. The primary outcome was the rate of abnormal EKG or echo, defined as abnormal cardiac structure and/or function, among patients who were determined to be at increased risk for CVD.

Results:

Of 29 patients identified to be at increased risk, 20 received follow-up testing with EKG or echo within 60 days of the risk assessment. Over half (65%) of the patients were found to have underlying EKG or echo abnormality. Abnormal cardiovascular testing results included findings such as sinus tachycardia (HR > 100 bpm), conduction delays, Wolff Parkinson-White syndrome, left ventricular hypertrophy/diastolic dysfunction, and chamber dilation. Using these results as a surrogate for CVD, the CMQCC risk assessment tool identified 13 cases of previously undiagnosed cardiovascular dysfunction in the study population (Table 1).

Conclusion:

Use of the CMQCC CVD risk assessment tool provides an opportunity for early diagnosis of CVD that may allow for prompt clinical intervention in addition to patient education and promotion of healthy lifestyle changes. EKG and echo results may be used as intermediate outcomes to assess the positive predictive value of the tool. Future long-term studies should evaluate the benefits of obstetric CVD risk assessment on the prevention of CVD over the life course.

Primary & Presenting Author(s)

Emma J. Altieri, BA (she/her/hers)
Medical Student (MS4)
University of California, Irvine, School of Medicine
Irvine, California, United States

Coauthor(s)

HT
Heike Thiel de Bocanegra, PhD,MPH
Associate Professor
University of California, Irvine Medical Center
Orange, California, United States
JC
Jenny Chang, MPH
University of California, Irvine, School of Medicine
Orange, California, United States
MB
Manija Billah, BS
Clinical research coordinator
University of California, Irvine
Irvine, California, United States
Afshan B. Hameed, MD
Professor Maternal Fetal Medicine & Cardiology
University of California, Irvine
Orange, California, United States