Global cardiac risk assessment in the Registry Of Pregnancy And Cardiac disease: results of a registry from the European Society of Cardiology

Abstract

Aims To validate the modified World Health Organization (mWHO) risk classification in advanced and emerging countries, and to identify additional risk factors for cardiac events during pregnancy. Methods and results The ongoing prospective worldwide Registry Of Pregnancy And Cardiac disease (ROPAC) included 2742 pregnant women (mean age ± standard deviation, 29.2 ± 5.5 years) with established cardiac disease: 1827 from advanced countries and 915 from emerging countries. In patients from advanced countries, congenital heart disease was the most prevalent diagnosis (70%) while in emerging countries valvular heart disease was more common (55%). A cardiac event occurred in 566 patients (20.6%) during pregnancy: 234 (12.8%) in advanced countries and 332 (36.3%) in emerging countries. The mWHO classification had a moderate performance to discriminate between women with and without cardiac events (c‐statistic 0.711 and 95% confidence interval (CI) 0.686–0.735). However, its performance in advanced countries (0.726) was better than in emerging countries (0.633). The best performance was found in patients with acquired heart disease from developed countries (0.712). Pre‐pregnancy signs of heart failure and, in advanced countries, atrial fibrillation and no previous cardiac intervention added prognostic value to the mWHO classification, with a c‐statistic of 0.751 (95% CI 0.715–0.786) in advanced countries and of 0.724 (95% CI 0.691–0.758) in emerging countries. Conclusion The mWHO risk classification is a useful tool for predicting cardiac events during pregnancy in women with established cardiac disease in advanced countries, but seems less effective in emerging countries. Data on pre‐pregnancy cardiac condition including signs of heart failure and atrial fibrillation, may help to improve preconception counselling in advanced and emerging countries.

Risk factors in pregnancy with heart disease and their co-relation with adverse feto-maternal outcome

“…This is also the finding of large ROPAC Study by van Hagen IM, which concluded that WHO classification is a moderately accurately tool for predicting adverse events in advanced countries but suboptimal in developing nations. 15 Acquired heart disease, seen in developing nations are underrepresented in WHO classification, as found in an African study done in 1914. 15 Studies having preponderance of congenital heart disease subjects show more accuracy of WHO classification for prediction of adverse maternal outcome as the study done by Domenech P et al had 68% CHD but only 16% valvopathies.…”

“…15 Acquired heart disease, seen in developing nations are underrepresented in WHO classification, as found in an African study done in 1914. 15 Studies having preponderance of congenital heart disease subjects show more accuracy of WHO classification for prediction of adverse maternal outcome as the study done by Domenech P et al had 68% CHD but only 16% valvopathies. 16 Another alarming observation was the total lack of pre-pregnancy counseling in all of the study population despite living in capital of India.…”

Pregnancy and Delivery Management of Women With Aorta and Aortic Valve Pathology

“…Синусовая тахикардия 3 (13,6) Синусовая брадикардия 1 (4,5) высоких градаций, потребовавших назначения меди-каментозной терапии (10,7%, n=6) и сердечной недо-статочности. За время беременности у 3 пациенток (5,4%) отмечено прогрессивное нарастание одышки, снижение толерантности к физической нагрузке и повышение уровня NT-proBNP.…”

“…Патология аортального клапана (АК) и аорты занимает особое место в структуре экстрагениталь-ной патологии и сопровождается высоким риском осложнений, что отражено в модифицированной классификации материнского риска Всемирной организации здравоохранения (ВОЗ) [3,4].…”

“…Это связано с тем, что в случае наступ-ления беременности у пациенток с врожденным пороком сердца (ВПС) или синдромом Марфана, имеющих аневризматическое расширение аорты более 55мм, материнская смертность может достигать 8-35%, а тяжелые осложнения регистрируются в 50% случаев [1,3,5]. Даже само прерывание беременности у этих больных сопряжено с высоким риском разви-тия осложнений вследствие периферической вазоди-латации и уменьшения сократительной способности миокарда на фоне анестезии [1][2][3][4]. Вместе с тем, совершенствование медицинской техники и появле-ние новых лекарственных препаратов способствует снижению частоты осложнений, включая летальные исходы.…”