Exploring Pregnancy Outcomes in HFpEF and Cardiac Amyloidosis: Rayan Salih, MD

At the ASPC 2025 Congress on CVD Prevention, Rayan Salih, MD, a third-year internal medicine resident with the Northeast Georgia Health System, who hopes to further specialize in cardiology, presented the poster, “Double Trouble: Pregnancy Challenges in Heart Failure With Preserved Ejection Fraction and Cardiac Amyloidosis.” Here she discusses why studying Hhart failure with preserved ejection fraction (HFpEF) and cardiac amyloidosis is important and tells about the case of a young pregnant patient with new-onset heart failure who inspired this investigation.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

Can you discuss the importance of investigating HFpEF and cardiac amyloidosis in pregnancy?

When I was doing my heart failure rotation, we had a consult with this young lady who had blast pulmonary edema—swelling everywhere—and it was new-onset heart failure. Obviously, we got the labs, the initial labs, the chest x-ray, and the echo [echocardiography], and surprisingly, she had the specific finding on the echo for cardiac amyloidosis, which is a cherry on top [apical sparing], and the wall thickness and all of that, which prompted us to even further consider cardiac amyloidosis as a reason why she has this acute exacerbation of heart failure.

At that time, I thought, "Okay, she is young; this is a young lady," and we could have easily missed the diagnosis, given that she's pregnant and pregnancy also causes swelling, shortness of breath, or heart failure symptoms. At that time, I was like, "Okay, what are the complications with cardiac amyloidosis and then the pregnancy complications?" We looked at patients who have HFpEF and cardiac amyloidosis, who are pregnant, and 18 years and older, and compared that to patients who are pregnant and have only HFpEF to just focus on the cardiac amyloidosis part and try to find the outcomes from that.

The primary outcome actually was mortality rate. Secondary outcomes were heart failure exacerbation [and] pregnancy complications, including preeclampsia, placental abruption, [and] growth restriction, and surprisingly, the mortality was lower in the population who had cardiac amyloidosis and HFpEF in comparison to people who had HFpEF [alone]. I think this is probably mainly because patients with cardiac amyloidosis are more likely to have an established heart failure specialist and cardio-obstetric specialist, and they probably have more follow-ups during pregnancy and more eyes.

Other findings that we found [are that] the patients with cardiac amyloidosis tend to have more rates of intrauterine growth restriction and placental abruption. While this is mainly an observational study, what I think of this is maybe [with] cardiac amyloidosis—as we know, it's a deposition of altered proteins in the body, prealbumin—maybe that protein is also deposited to the uterus and that is causing that, [but] we don't know. We need more research to figure out why this is happening.