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

Autor: van Hagen IM; Department of Cardiology, Erasmus MC, Thoraxcenter, Department of Cardiology Ba583a, PO Box 2040, 3000, CA, Rotterdam, the Netherlands., Boersma E; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands., Johnson MR; Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK., Thorne SA; Adult Congenital Heart Disease Unit, Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK., Parsonage WA; Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia., Escribano Subías P; Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain., Leśniak-Sobelga A; Department of Cardiac and Vascular Diseases, Jagiellonian University School of Medicine, John Paul II Hospital, Kraków, Poland., Irtyuga O; Almazov Federal North-West Medical Research Centre, Saint Petersburg, Russia., Sorour KA; Department of Cardiology, Kasr El Aini Hospital, Faculty of Medicine, Cairo University, Egypt., Taha N; Department of Cardiology, Faculty of Medicine, El Minya University Hospital, Minya, Egypt., Maggioni AP; ANMCO Research Centre, Florence, Italy.; ESC, Sophia Antipolis Cedex, France., Hall R; Department of Cardiology, Norwich Medical School, University of East Anglia, Norwich, UK., Roos-Hesselink JW; Department of Cardiology, Erasmus MC, Thoraxcenter, Department of Cardiology Ba583a, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.; ESC, Sophia Antipolis Cedex, France.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2016 May; Vol. 18 (5), pp. 523-33. Date of Electronic Publication: 2016 Mar 22.
DOI: 10.1002/ejhf.501
Abstrakt: 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.
(© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.)
Databáze: MEDLINE
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