title: Cardiac complications during pregnancy are better predicted with the modified WHO risk score.
abstract: OBJECTIVE
  Several risk scores (RSs) have been used to stratify risk of cardiac complications (CCs) in pregnant patients with heart disease. We aimed to compare and contrast the accuracy of several RSs for predicting CC in this population.
  
  
  METHODS
  Prospective inclusion of all consecutive pregnant patients with heart disease, and follow-up until 6 months postpartum. CCs were defined as primary if admission was required due to heart failure, arrhythmia or thromboembolic events, and secondary if the decline in NYHA class compared with baseline was >2 or urgent invasive cardiac procedures were needed. The discriminatory power of each RS was assessed by the area-under-the receiver-operating characteristic (ROC) curve (AUC).
  
  
  RESULTS
  179 patients, mean age: 32 years, accounted for 13.4% of CC (primary 11.7%, secondary 1.7%); the main diagnosis was congenital heart disease (CHD) in 68% followed by valvulopathies in 16%, arrhythmia in 7% and myocardiopathies in 5%. 22% (n=40) were classified as mWHO=1, 59% (n=105) mWHO=2 including subgroup 2-3, 14% (n=26) mWHO=3 and 4%(n=7) mWHO=4; 1 patient was unclassifiable. mWHO showed a better AUC (0.763) than CARPREG (0.67). For the CHD population, ZAHARA RS showed an AUC of 0.74, and Khairy an AUC of 0.632.
  
  
  CONCLUSIONS
  mWHO was better at predicting CC than CARPREG; mWHO was also better at predicting CC than the specific CHD RS in the CHD subgroup.
  
  
  CONCLUSIONS
  There are an increasing number of pregnant women with HD.
  
  
  CONCLUSIONS
  Improved prediction of CC risk during pregnancy can provide better preconception assessment in women with HD.
authors.affiliation: Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain; Department of Cardiology, University Hospital Valld'Hebron, Barcelona, Spain. Electronic address: tonyapijuan@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Pijuan-Domènech
authors.affiliation: Department of Cardiology, University Hospital Valld'Hebron, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Galian
authors.affiliation: Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Goya
authors.affiliation: Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Casellas
authors.affiliation: Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Merced
authors.affiliation: Department of Cardiology, University Hospital Valld'Hebron, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Ferreira-Gonzalez
authors.affiliation: Department of Cardiology, University Hospital Valld'Hebron, Barcelona, Spain.
authors.forename: J R
authors.initials: JR
authors.lastname: Marsal-Mora
authors.affiliation: Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain; Department of Cardiology, University Hospital Valld'Hebron, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Dos-Subirà
authors.affiliation: Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain; Department of Cardiology, University Hospital of Sant Pau I la Santa Creu, Barcelona, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Subirana-Domènech
authors.affiliation: Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain; Department of Cardiology, University Hospital Valld'Hebron, Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Pedrosa
authors.affiliation: Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Baró-Marine
authors.affiliation: Department of Anesthesiology, Hospital Valld'Hebron, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Manrique
authors.affiliation: Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain; Department of Cardiology, University Hospital Valld'Hebron, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Casaldàliga-Ferrer
authors.affiliation: Department of Cardiology, University Hospital Valld'Hebron, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Tornos
authors.affiliation: Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Cabero
authors.affiliation: Department of Cardiology, University Hospital Valld'Hebron, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Garcia-Dorado
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000453:epidemiology; D009202:Cardiomyopathies / Q000150:complications / Q000453:epidemiology; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000150:complications / Q000453:epidemiology; D006801:Humans; D016742:Preconception Care / Q000379:methods; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: Cardiac complications during pregnancy; Congenital heart disease; Pregnancy