MODERN APPROACHES TO DIAGNOSTICS AND MANAGEMENT OF CARDIOVASCULAR PATHOLOGY IN PREGNANT WOMEN: FROM INNOVATIONS TO CLINICAL REALITIES OF UZBEKISTAN
Keywords:
Cardiovascular diseases (CVD), 3D echocardiography, speckle-tracking imaging, cardiovascular magnetic resonance (CMR), biomarkers, preconception counseling, clinical protocols, Uzbekistan.Abstract
Cardiovascular diseases (CVD) are the leading cause of maternal mortality. Pregnancy creates a unique hemodynamic load, decompensating existing or provoking new pathologies (for example, peripartum cardiomyopathy). Modern management is based on innovative diagnostics (3D echocardiography, speckle-tracking, cardioMRI, new biomarkers), preconception counseling using risk stratification (mWHO) and the work of multidisciplinary teams. The key benchmarks are current guidelines (ESC 2023, AHA / ACC, WHO, RCOG). Over the past 5 years, Uzbekistan has developed a specialized clinical protocol for the management of pregnant women with CVD, adapted to national realities and based on international standards, which is an important step in reducing maternal mortality.
References
Regitz-Zagrosek V, et al. 2023 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2023; ehad655. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehad655/7330755
WHO. Maternal mortality. Fact sheet, 2023. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation. 2014; 130(12):1003-8. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.114.009029
Bauersachs J, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019;21(7):827-843. https://onlinelibrary.wiley.com/doi/10.1002/ejhf.1493
Roos-Hesselink JW, et al. Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. Eur Heart J. 2013;34(9):657-65. https://academic.oup.com/eurheartj/article/34/9/657/455400
Donal E, et al. Speckle tracking echocardiography: a new technique for assessing myocardial function. J Mal Vasc. 2011;36(5):336-41. https://pubmed.ncbi.nlm.nih.gov/21802227/
Farsalinos KE, et al. Assessment of left ventricular function by three-dimensional speckle-tracking echocardiography in peripartum cardiomyopathy. Circ Cardiovasc Imaging. 2015;8(5):e002872. https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.114.002872
Donofrio MT, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014;129(21):2183-242. https://www.ahajournals.org/doi/10.1161/01.cir.0000437597.44550.5d
Haghikia A, et al. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J. 2015;36(18):1090-7. https://academic.oup.com/eurheartj/article/36/18/1090/2293334
Zeisler H, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med. 2016;374(1):13-22. https://www.nejm.org/doi/10.1056/NEJMoa1414838
Greiser A, et al. Cardiovascular magnetic resonance in pregnancy: insights from the German Registry for Pregnancy and Heart Disease (ROPAC). Eur Heart J Cardiovasc Imaging. 2020;21(1):112-120. https://academic.oup.com/ehjcimaging/article/21/1/112/5531221
Valente AM, et al. Multimodality Imaging Guidelines for Patients with Repaired Tetralogy of Fallot: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27(2):111-41. https://www.onlinejase.com/article/S0894-7317(13)00885-6/fulltext
Pieper PG, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147-97. https://academic.oup.com/eurheartj/article/32/24/3147/469434
Silversides CK, et al. Pregnancy outcomes in women with heart disease: the CARPREG II study. J Am Coll Cardiol. 2018;71(21):2419-2430. https://www.jacc.org/doi/10.1016/j.jacc.2018.02.076
EMA. Use of medicines during pregnancy. https://www.ema.europa.eu/en/human-regulatory-overview/public-health-topics/use-medicines-during-pregnancy
Stout KK, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease. Circulation. 2019;139(14):e698-e800. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000603
WHO. WHO recommendation on the use of low-dose acetylsalicylic acid for the prevention of pre-eclampsia. 2021. https://www.who.int/publications/i/item/9789240035720
Otto CM, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923 (Секция по беременности актуальна)
WHO. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. 2011 https://www.who.int/publications/i/item/9789241548335
RCOG. Green-top Guideline No. 13: Cardiac Disease and Pregnancy. 2023 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/cardiac-diseases-and-pregnancy-green-top-guideline-no-13/
RCOG. Green-top Guideline No. 37a: Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium. 2015. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/reducing-the-risk-of-thrombosis-and-embolism-during-pregnancy-and-the-puerperium-green-top-guideline-no-37a/
Хомидова Ш. М. Уровень антимюллерова гормона у женщин с преждевременным истощением яичников //Достижения науки и образования. – 2020. – №. 3 (57). – С. 104-107.
Хомидова Ш. М. РЕПРОДУКТИВНОЕ ЗДОРОВЬЕ: КЛЮЧЕВЫЕ АСПЕКТЫ ДЛЯ ЖЕНЩИН //Eurasian Journal of Medical and Natural Sciences. – 2024. – Т. 4. – №. 7. – С. 30-33.
Тоджиева Н. И. ПРИМЕНЕНИЕ ФОЛИЕВОЙ КИСЛОТЫ ПРИ БЕРЕМЕННОСТИ: ПРАВИЛЬНАЯ ДОЗА ЗАЛОГ УСПЕХА //Eurasian Journal of Medical and Natural Sciences. – 2024. – Т. 4. – №. 5-1. – С. 142-146.
