title: Global cardiac risk assessment in the Registry Of Pregnancy And Cardiac disease: results of a registry from the European Society of Cardiology.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Cardiology, Erasmus MC, Thoraxcenter, Department of Cardiology Ba583a, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
authors.forename: Iris M
authors.initials: IM
authors.lastname: van Hagen
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.affiliation: Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Johnson
authors.affiliation: Adult Congenital Heart Disease Unit, Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Thorne
authors.affiliation: Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
authors.affiliation: Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Escribano Subías
authors.affiliation: Department of Cardiac and Vascular Diseases, Jagiellonian University School of Medicine, John Paul II Hospital, Kraków, Poland.
authors.forename: Agata
authors.initials: A
authors.lastname: Leśniak-Sobelga
authors.affiliation: Almazov Federal North-West Medical Research Centre, Saint Petersburg, Russia.
authors.forename: Olga
authors.initials: O
authors.lastname: Irtyuga
authors.affiliation: Department of Cardiology, Kasr El Aini Hospital, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Sorour
authors.affiliation: Department of Cardiology, Faculty of Medicine, El Minya University Hospital, Minya, Egypt.
authors.forename: Nasser
authors.initials: N
authors.lastname: Taha
authors.affiliation: ANMCO Research Centre, Florence, Italy.|ESC, Sophia Antipolis Cedex, France.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Department of Cardiology, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Hall
authors.affiliation: Department of Cardiology, Erasmus MC, Thoraxcenter, Department of Cardiology Ba583a, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.|ESC, Sophia Antipolis Cedex, France.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology; D000328:Adult; D000784:Aortic Dissection / Q000453:epidemiology; D001014:Aortic Aneurysm / Q000453:epidemiology; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D002309:Cardiology; D019049:Developed Countries; D003906:Developing Countries; D005060:Europe; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology*; D006333:Heart Failure / Q000453:epidemiology*; D006349:Heart Valve Diseases / Q000453:epidemiology*; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D012955:Societies, Medical; D014944:World Health Organization; D055815:Young Adult
keywords: Cardiac disease; Pregnancy; Risk prediction