title: Comparison of 3 Risk Estimation Methods for Predicting Cardiac Outcomes in Pregnant Women With Congenital Heart Disease.
abstract: BACKGROUND
  Three risk estimation methods for predicting the cardiac outcomes of pregnancy in women with heart disease have been proposed. This study was designed to compare their prediction performance in an Asian cohort with congenital heart disease (CHD).
  
  
  RESULTS
  This study enrolled pregnant women with CHD who delivered their babies after the 20th gestational week between 1985 and 2011. Of 268 pregnancies in 190 women with CHD, 18 (6.7%) had cardiac complications. The incidence of maternal cardiac events among women with a CARPREG index of 0, 1 or 2 was 3.4%, 27.3% and 100%. The incidence was 2.7%, 8.6%, 11.1%, 40% and 17.6% for those with a ZAHARA score 0-0.5, 0.51-1.5, 1.51-2.5, 2.51-3.5 and >3.5. Among patients with a modified World Health Organization (WHO) classification I, II, III and IV, the incidence of maternal cardiac events was 0%, 4.0%, 12.2% and 25.7%. The c-statistic was 0.732 (95% confidence interval (CI): 0.589, 0.876; P<0.001) for the CARPREG score, 0.737 (95% CI: 0.611, 0.864; P=0.001) for the ZAHARA score and 0.827 (95% CI: 0.745, 0.909; P<0.001) for the WHO classification.
  
  
  CONCLUSIONS
  All 3 risk estimation methods had good performance in predicting maternal cardiac outcomes; however, the modified WHO classification demonstrated superior discrimination and calibration.
authors.affiliation: Adult Congenital Heart Center, National Taiwan University Hospital.
authors.forename: Chun-Wei
authors.initials: CW
authors.lastname: Lu
authors.forename: Jin-Chung
authors.initials: JC
authors.lastname: Shih
authors.forename: Ssu-Yuan
authors.initials: SY
authors.lastname: Chen
authors.forename: Hsin-Hui
authors.initials: HH
authors.lastname: Chiu
authors.forename: Jou-Kou
authors.initials: JK
authors.lastname: Wang
authors.forename: Chun-An
authors.initials: CA
authors.lastname: Chen
authors.forename: Shuenn-Nan
authors.initials: SN
authors.lastname: Chiu
authors.forename: Ming-Tai
authors.initials: MT
authors.lastname: Lin
authors.forename: Chien-Nan
authors.initials: CN
authors.lastname: Lee
authors.forename: Mei-Hwan
authors.initials: MH
authors.lastname: Wu
mesh_terms: D000328:Adult; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D008297:Male; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment