Global cardiac risk assessment in the Registry of Pregnancy and Cardiac disease: Results of a registry from the European Society of Cardiology

ROPAC investigators

Research output: Contribution to journalArticle

29 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)523-533
Number of pages11
JournalEuropean Journal of Heart Failure
Volume18
Issue number5
DOIs
StatePublished - May 1 2016

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Registries
Heart Diseases
Pregnancy
Confidence Intervals
Atrial Fibrillation
Heart Failure
Heart Valve Diseases
Developed Countries
Counseling
Pregnant Women

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{7cb146efa7b3438e8d15f1c0c6b3f7d0,
title = "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.",
author = "{ROPAC investigators} and {Van Hagen}, {Iris M.} and Eric Boersma and Johnson, {Mark R.} and Thorne, {Sara A.} and Parsonage, {William A.} and {Escribano Sub{\'i}as}, Pilar and Agata Leśniak-Sobelga and Olga Irtyuga and Sorour, {Khaled A.} and Nasser Taha and Maggioni, {Aldo P.} and Roger Hall and Roos-Hesselink, {Jolien W.} and Roberto Ferrari and Ariane Marelli and Harald Kaemmerer and Jana Popelova and Luigi Tavazzi and Joerg Stein and Uri Elkayam and Ulf Thilen and Titia Ruys and Panos Vardas and Michel Komajda and Fausto Pinto and Angeles Alonso and David Wood and Nikolaos Maniadakis and Thierry Ferreira and G{\'e}rard Gracia and C{\'e}cile Laroche and Viviane Missiamenou and Charles Taylor and Mar{\`e}me Konte and Maryna Andarala and Emanuela Fiorucci and Lefrancq, {Elin Folkesson} and Myriam Gl{\'e}mot and McNeill, {Patti Ann} and Caroline Pommier and Myriam Lafay and A. Aquieri and Vega, {H. Ruda} and K. Lust and N. Fagermo and H. Gabriel and E. Donhauser and Z. Gasimov and T. Jahangirov and William Davidson",
year = "2016",
month = "5",
day = "1",
doi = "10.1002/ejhf.501",
language = "English (US)",
volume = "18",
pages = "523--533",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",
number = "5",

}

Global cardiac risk assessment in the Registry of Pregnancy and Cardiac disease : Results of a registry from the European Society of Cardiology. / ROPAC investigators.

In: European Journal of Heart Failure, Vol. 18, No. 5, 01.05.2016, p. 523-533.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Global cardiac risk assessment in the Registry of Pregnancy and Cardiac disease

T2 - Results of a registry from the European Society of Cardiology

AU - ROPAC investigators

AU - Van Hagen, Iris M.

AU - Boersma, Eric

AU - Johnson, Mark R.

AU - Thorne, Sara A.

AU - Parsonage, William A.

AU - Escribano Subías, Pilar

AU - Leśniak-Sobelga, Agata

AU - Irtyuga, Olga

AU - Sorour, Khaled A.

AU - Taha, Nasser

AU - Maggioni, Aldo P.

AU - Hall, Roger

AU - Roos-Hesselink, Jolien W.

AU - Ferrari, Roberto

AU - Marelli, Ariane

AU - Kaemmerer, Harald

AU - Popelova, Jana

AU - Tavazzi, Luigi

AU - Stein, Joerg

AU - Elkayam, Uri

AU - Thilen, Ulf

AU - Ruys, Titia

AU - Vardas, Panos

AU - Komajda, Michel

AU - Pinto, Fausto

AU - Alonso, Angeles

AU - Wood, David

AU - Maniadakis, Nikolaos

AU - Ferreira, Thierry

AU - Gracia, Gérard

AU - Laroche, Cécile

AU - Missiamenou, Viviane

AU - Taylor, Charles

AU - Konte, Marème

AU - Andarala, Maryna

AU - Fiorucci, Emanuela

AU - Lefrancq, Elin Folkesson

AU - Glémot, Myriam

AU - McNeill, Patti Ann

AU - Pommier, Caroline

AU - Lafay, Myriam

AU - Aquieri, A.

AU - Vega, H. Ruda

AU - Lust, K.

AU - Fagermo, N.

AU - Gabriel, H.

AU - Donhauser, E.

AU - Gasimov, Z.

AU - Jahangirov, T.

AU - Davidson, William

PY - 2016/5/1

Y1 - 2016/5/1

N2 - 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.

AB - 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.

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U2 - 10.1002/ejhf.501

DO - 10.1002/ejhf.501

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