{
  "abstract": "Background Cardiovascular adaptation to pregnancy is more marked in twin than singleton pregnancies and may result in a higher rate of adverse cardiac events in women with heart disease. The objective was to test the hypothesis that women with heart disease and a twin pregnancy have a higher rate of adverse cardiac events.Methods and results Registry Of Pregnancy And Cardiac disease (ROPAC) is a prospective (2007–2018), global registry of pregnant women with heart disease. Pregnancy outcomes in twin (n=96) were compared with 5643 women with singleton pregnancies. At baseline, twin mothers were older (32.1 vs 29.5 years, p<0.001) and had fewer prior cardiac interventions (43% vs 55.5%, p=0.02). Cardiac diagnosis, New York Heart Association class, modified WHO class, country of origin, prior hypertension, diabetes mellitus, atrial fibrillation and signs of heart failure were similar. The risk of heart failure was significantly higher in twin pregnancies, with 24/96 developing heart failure vs 631/5643 singleton (25 vs 11.2%, p<0.001), but there were no differences in maternal mortality, arrhythmia, endocarditis, thrombosis, dissection, acute coronary syndrome or hospital admission for cardiac reasons. Multivariable analysis of the whole ROPAC population showed that twin pregnancy was a risk factor for heart failure, and that within the twin pregnancies, cardiomyopathy and prior heart failure were risk factors for development of heart failure. Women with valvular or congenital heart disease experienced heart failure during pregnancy, but those with cardiomyopathy experienced it during the peripartum period. Obstetric outcomes were worse in twins.Conclusions Women with heart disease and a twin pregnancy have twice the risk of heart failure, particularly in those with a prior diagnosis of cardiomyopathy.",
  "authors": [
    {
      "affiliations": [
        "Metabolism, Digestion and Reproduction, Imperial College London, London, UK",
        "Department of Obstetrics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Gurleen Wander"
    },
    {
      "affiliations": [
        "Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands",
        "Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, Netherlands"
      ],
      "name": "Johanna A van der Zande"
    },
    {
      "affiliations": [
        "Cardiology Clinic, Hacettepe Universitesi, Ankara, Turkey"
      ],
      "name": "Uğur Canpolat"
    },
    {
      "affiliations": [
        "Cardiology, Lausanne University Hospital, Lausanne, Switzerland",
        "Cardiology, Geneva University Hospital Main Building, Geneva, Switzerland"
      ],
      "name": "Judith Bouchardy"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden"
      ],
      "name": "Eva Furenäs"
    },
    {
      "affiliations": [
        "Cardiology, University Health Authority Giuliano-Isontina, Trieste, Italy"
      ],
      "name": "Bianca D’ Agata"
    },
    {
      "affiliations": [
        "Adult Congenital and Valvular Heart Disease Center, Department of Cardiology, University Hospital Munster, Münster, Germany"
      ],
      "name": "Gerhard Paul Diller"
    },
    {
      "affiliations": [
        "Department of Cardiology, Brugmann University Hospital, Brussels, Belgium"
      ],
      "name": "Marielle Morissens"
    },
    {
      "affiliations": [
        "Cardiology, Tikur Anbessa Hospital, Addis Ababa, Ethiopia"
      ],
      "name": "Desalewm Mekonnen"
    },
    {
      "affiliations": [
        "Department of Cardiology, University of East Anglia Norwich Medical School, Norwich, UK"
      ],
      "name": "Roger Hall"
    },
    {
      "affiliations": [
        "Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands"
      ],
      "name": "Jolien W Roos-Hesselink"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK",
        "Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK"
      ],
      "name": "Mark Richard Johnson"
    },
    {
      "affiliations": [
        "Metabolism, Digestion and Reproduction, Imperial College London, London, UK",
        "Department of Obstetrics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK",
        "Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands",
        "Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, Netherlands",
        "Cardiology Clinic, Hacettepe Universitesi, Ankara, Turkey",
        "Cardiology, Lausanne University Hospital, Lausanne, Switzerland",
        "Cardiology, Geneva University Hospital Main Building, Geneva, Switzerland",
        "Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden",
        "Cardiology, University Health Authority Giuliano-Isontina, Trieste, Italy",
        "Adult Congenital and Valvular Heart Disease Center, Department of Cardiology, University Hospital Munster, Münster, Germany",
        "Department of Cardiology, Brugmann University Hospital, Brussels, Belgium",
        "Cardiology, Tikur Anbessa Hospital, Addis Ababa, Ethiopia",
        "Department of Cardiology, University of East Anglia Norwich Medical School, Norwich, UK",
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK",
        "Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK"
      ],
      "name": "EORP Oversight Committee"
    },
    {
      "affiliations": [
        "Metabolism, Digestion and Reproduction, Imperial College London, London, UK",
        "Department of Obstetrics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK",
        "Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands",
        "Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, Netherlands",
        "Cardiology Clinic, Hacettepe Universitesi, Ankara, Turkey",
        "Cardiology, Lausanne University Hospital, Lausanne, Switzerland",
        "Cardiology, Geneva University Hospital Main Building, Geneva, Switzerland",
        "Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden",
        "Cardiology, University Health Authority Giuliano-Isontina, Trieste, Italy",
        "Adult Congenital and Valvular Heart Disease Center, Department of Cardiology, University Hospital Munster, Münster, Germany",
        "Department of Cardiology, Brugmann University Hospital, Brussels, Belgium",
        "Cardiology, Tikur Anbessa Hospital, Addis Ababa, Ethiopia",
        "Department of Cardiology, University of East Anglia Norwich Medical School, Norwich, UK",
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK",
        "Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK"
      ],
      "name": "ROPAC Executive Committee"
    },
    {
      "affiliations": [],
      "name": "Investigators"
    }
  ],
  "title": "Twin pregnancies in women with heart disease are complicated by high risk of heart failure: data from the EORP ROPAC Registry",
  "uid": "9e367ef1-e900-5cb1-83e1-b8f98cd7f583"
}