Heart Disease in Pregnancy: Validity of CARPREG Score in local population

1. Heart Disease in Pregnancy: Validity of CARPREG Score in local population Eliza M.N (1), Quek Y.S. (1), Woon S.Y. (1), Ravichandan N. (2), Ravichandran J. (1) 1. Hospital Sultanah Aminah Johor Bahru, Malaysia 2. Singapore General Hospital OPTIONALLOGO HERE OPTIONALLOGO HERE Objectives Results Results Conclusions The main finding of this study is that pregnant women with various forms of heart disease experience an overall low risk of cardiac complications if their CARPREG score is low. This cardiac event observed was lower than most studies done. In our study we categorized patients according to the previous validated carpreg score, however some limitations of the carpreg score must be recognized. Lesion specific predictors need to be incorporated in the scoring and prior cardiac event such as arrhythmia would be too vague as the outcome for treated and treated event was not mentioned specifically. As for NYHA class, it would patient and the doctors own evaluation which may sometimes be inaccurate. Several limitations of our study also needs to be considered as some patients who were discharged home may have had a cardiac event which have been missed. In conclusion, the cardiac events observed in our study was relatively lower compared to the standard outcome in the CARPREG scoring system, thus a different method or scoring system is required in our local setting. More research and bigger studies need to be done to assess the validity of this scoring system and other scoring system as well . Report of Confidential enquiry into maternal deaths in 1997-2000 showed that the commonest cause of death is due to medical disorders in pregnancy which consists of 20.6%. Heart disease in pregnancy is the leading cause of death due to medical disorders especially due to valvular lesions and followed by congenital heart disease. There are four predictors used to determine mortality associated with heart disease, called CARPREG score. They are prior cardiac event ( heart failure/ stroke ), baseline NYHA >II, left heart obstruction ( mitral area <2cm, aortic area < 1.5cm or peak left ventricular outflow gradient > 30mmhg by ECHO ) and reduced systemic ventricular ejection fraction ( < 40% ) . This study is to asses the validity of a risk score index (CARPREG) in predicting maternal and perinatal outcome in pregnant patients with heart diseases in our population. Majority of our patients were grouped in Carpreg 0 (Figure 1). Ocurrence of cardiac events were further subcategorized into congenital or acquired heart disease in relation to carpreg score category (Table 3 & 4). Table 3. Cardiac Events in Acquired Heart Disease Data presented as n (%) Table 4. Cardiac Events in Congenital Heart Disease Among 150 cases recruited, 61 of them were congenital heart disease with 89 acquired heart disease (Table 1). Occurrence of cardiac events in relation to carpreg score category were as in Table 2. Table 1. Carpreg Score in different cardiac disease Methods Data presented as n (%). * Not applicable A prospective observational study in pregnant women diagnosed with heart disease for 1 year duration involving 150 patients managed by combine obstetrician and cardiologist. Patients went through CARPREG risk scoring and their cardiac events were observed. The rate of cardiac complications according to the CARPREG score for a patient with a score of 0,1 and >1 was 5%, 27% and 75% respectively. The demographic data for all these patients were also observed. Data presented as n (%) All these cardiac event was heart failure , however there was one maternal death and this occurred postpartum in the CARPREG 1 group. The patient was a 33 year old primigravida who was diagnosed to have chronic rheumatic heart disease and had severe aortic stenosis. She was admitted from 30 weeks onwards and was on beta blockers, aspirin and metoprolol. The pregnancy ended up with an IUD and was delivered via caeserian section. She succumbed to the illness during postpartum. References Table 2. Carpreg Score and Cardiac Events • 1. Jastrow N, Meyer P, Kahiry P, et al. Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center. Int. J Cardiol 2011;151:209-213. • 2. Ruth C., Swan L., Steera PJ. Cardiac disease in pregnancy. Curr Opinion Obstet Gynecol 2009;21:508-513. • 3. Willem D., Eric B., Balci A., et al. Predictors of pregnancy complications in women with congenital heart disease. European Heart J 2010;31:2124-2132. • 4. Samuel CS, Sermer M, Colman JM, et al. Prospective Multicenter Study of Pregnancy Outcomes in Women with Heart Disease. Am Heart Assoc Circulation 2001; 104:515-521. • 5. Paul K., Ouyang DW., Fernandes SM., et al. Pregnancy Outcomes in Women with Congenital Heart Disease. Am J Heart Assoc 2006; 113:517-524. Data presented as n (%)