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Improving the Heart Health of Young Women and Mothers

Adverse health conditions and death from pregnancy and delivery are more common in the United States than in other developed countries, with women of color two to four times more likely than white women to die from a pregnancy complication. Cardiovascular disease is the leading cause of pregnancy-related death, and an increasing number of young American women have one or more cardiovascular risk factors, such as obesity, sleep apnea, or high blood pressure. Moreover, blood pressure elevation occurs earlier in life and progresses more rapidly in women, compared with men. For these reasons, we need to address maternal morbidity and mortality throughout a woman’s life, not just during her reproductive years.

The NHLBI supports studies that aim to understand the impact of sex as a biological variable and to improve women’s heart health across the lifespan.

  • The Chronic Hypertension and Pregnancy (CHAP) trial is examining the safety and effectiveness of using medication to treat mild hypertension in pregnancy, treatment of which is typically deferred unless a woman has severe high blood pressure. Enrollment of 2,400 women of diverse race and ethnicity from 62 sites across the United States is underway, and study results are expected by the end of 2021. Learn more about this clinical trial.
  • A study of 1.4 million maternal and newborn records found that children born to mothers who had sleep apnea during pregnancy were more likely to have birth defects, be admitted to the neonatal intensive care unit, or require resuscitation at birth. A trial funded in part by the NHLBI is now investigating whether treating sleep apnea during pregnancy can improve outcomes for both mother and newborn.
  • In 2021, the NHLBI is inviting applications for clinical research on Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH). The goal is to determine whether cardiovascular health interventions delivered through home visiting programs can enhance maternal and early childhood outcomes, especially in low-resource or underserved communities. Read the funding opportunity announcement.
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Meeting NHLBI Strategic Vision Objectives 4, 5

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Leveraging New Technologies

New cardiac imaging tools and technologies are enabling clinicians to more rapidly diagnose and treat patients with a number of heart disorders.

  • An NHLBI-funded team recently developed a technique called electromechanical wave imaging (EWI) that uses ultrasound to see electrical waves moving through the heart with each beat. In a study of 55 patients, the researchers found that EWI pinpointed the origin for 96 percent of arrythmias (abnormal heartbeat) — an important step in treatment. In contrast, standard electrocardiography had a success rate of 71 percent.
  • NHLBI intramural investigators developed a new type of magnetic resonance imaging (MRI) called quantitative myocardial perfusion mapping that can improve identification of patients with heart disease who have two or more blocked coronary arteries.
  • 3D printing technologies are being developed that can repair damaged heart or vascular tissue or be used to engineer bioartificial hearts. NHLBI-supported researchers designed a 3D bioprinting device to build complex tubular networks that mimic human vascular networks. Others have printed 3D collagen, the main protein in the body’s fibrous tissues, and then embedded cells within it to produce several complex heart tissues, including capillaries, valves, and ventricles.
  • A new approach using artificial intelligence to examine ultrasound images of the heart (echocardiogram) can identify subtle signs of heart disease that may be missed by expert eyes.

 

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Addressing Heart Failure

The NHLBI is working to improve outcomes for those living with heart failure (HF). In HF with preserved ejection fraction (HFpEF), which accounts for about 50 percent of all HF cases but for which there are limited treatment options, the heart contracts normally but fills with blood too slowly. HeartShare is a new initiative to conduct large-scale analysis of clinical, laboratory, and imaging data from patients with HFpEF to characterize mechanisms of disease and identify potential therapeutic targets. Read the funding opportunity announcement for researchers.

Supporting Clinical Trial Networks

  • The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) compared two common approaches for managing ischemic heart disease among more than 5,000 patients. About half were treated with invasive procedures, including stenting, bypass surgery, and medications. The other half were treated with lifestyle changes and medications in lieu of surgery. After three years of follow-up, both approaches produced similar outcomes, but patients with chest pain who received the more invasive approach had better symptom relief and quality of life. These results will help inform treatment decisions for patients and their physicians.
  • The NHLBI renewed its commitment to the Cardiothoracic Surgical Trials Network (CTSN), which brings together scientists and surgeons across the country to move research from the proof-of-concept stage into clinical trials. As part of the CTSN, the Anticoagulation for New-Onset Post-Operative Atrial Fibrillation After CABG (PACES) trial is evaluating whether adding blood thinners to antiplatelet therapy can further reduce the risk of heart attack and stroke in patients who develop AFib after undergoing coronary artery bypass surgery.