We read with great interest the article by Chen et al. [1] entitled “Precipitating factors and maternal and neonatal outcomes of heart failure in pregnancy: a retrospective analysis in a large tertiary hospital in China, 2012–2017”. Although this is a well-designed study, we would like to address some points that merit more attention.

Pregnancy-associated heart failure is a rare but very serious problem which may cause severe complications in pregnancy [2]. Left ventricular ejection fraction is a very important parameter at pregnant heart failure patients. Previous studies show that heart failure with preserved ejection fraction is a major problem in older population but appears to be less dangerous and cause no major clinical effect in pregnancy [3]. Chen et al. [1] states that ejection fraction of the study population was 55.40 ± 4.54. Even though mean ejection fraction value is high, the patients show pregnancy-specific disorders such as preeclampsia and non-pregnancy-specific conditions such as lung infections and cardiac problems. These results show the clinicians that they must still be careful despite the high ejection fraction values. We should treat heart failure according to the patient's clinic, not numerical values.

At congenital heart disease patients, the impact of pregnancy and effects on long-term outcome is not well studied and not clear. These patients should be evaluated before pregnancy and risk assessment should be made [3]. In this paper, we saw that all maternal deaths are patients with various congenital heart conditions and Eisenmenger syndrome which shows the importance of this disorder [1]. Suspected congenital heart disease patients need immediate attention before and during pregnancy and must be treated in specialized centers by a multidisciplinary heart team [3].