Transcript Heart Disease in Pregnancy: Validity of CARPREG

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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)
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1. Hospital Sultanah Aminah Johor Bahru, Malaysia 2. Singapore General Hospital
Objectives
Results
Results
Majority of our patients were grouped in Carpreg 0 (Figure 1).
Report of Confidential enquiry into maternal deaths in 19972000 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
Conclusions
Ocurrence of cardiac events were further subcategorized
into congenital or acquired heart disease in relation to
various forms of heart disease experience an overall low risk of
carpreg score category (Table 3 & 4).
cardiac complications if their CARPREG score is low. This
Table 3. Cardiac Events in Acquired Heart Disease
cardiac event observed was lower than most studies done.
to medical disorders especially due to valvular lesions and
Carpreg
Carpreg
Carpreg
Score 0
Score 1
Score 2
Total
In our study we categorized patients according to the
Presence of Cardiac Event
followed by congenital heart disease. There are four
predictors used to determine mortality associated with heart
previous validated carpreg score, however some limitations of
Yes
1 (1.7)
3 (15.0)
1 (11.1)
5 (5.6)
No
59 (98.3)
17 (85.0)
8 (88.9)
84 (94.4)
Onset of Cardiac Event
disease, called CARPREG score. They are prior cardiac
event ( heart failure/ stroke ), baseline NYHA >II, left heart
1 (100)
1 (33.3)
1 (100)
3 (60)
Postpartum
0 (0)
2 (66.7)
0 (0)
2 (40)
Type of Cardiac Event
left ventricular outflow gradient > 30mmhg by ECHO ) and
Maternal
Mortality
Data presented
as n (%)
Heart Failure
1 (1.1)
2 (2.2)
1 (1.1)
4 (5.4)
0 (0)
1 (1.1)
0 (0)
1 (1.1)
Carpreg
Carpreg
Carpreg
This study is to asses the validity of a risk score index
with 89 acquired heart disease (Table 1). Occurrence of cardiac
Score 0
Score 1
Score 2
(CARPREG) in predicting maternal and perinatal outcome in
events in relation to carpreg score category were as in Table 2.
Yes
0 (0)
0 (0)
3 (75)
3 (4.9)
No
53 (100)
4 (100)
1 (25)
58 (95.1)
Carpreg Score
0
Methods
A prospective observational study in pregnant women
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.
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cardiac event which have been missed.
In conclusion, the cardiac events observed in our study was
Acquired
Total
Antepartum
NA*
NA*
2 (66.7)
2 (66.7)
relatively lower compared to the standard outcome in the
(n = 61)
(n = 89)
(n = 150)
Postpartum
NA*
NA*
1 (33.3)
1 (33.3)
CARPREG scoring system, thus a different method or scoring
53 (86.9)
60 (67.4)
113 (75.3)
NA*
NA*
2 (66.7)
2 (66.7)
system is required in our local setting. More research and
NA*
1 (33.3)
1 (33.3)
bigger studies need to be done to assess the validity of this
1
4 (6.6)
20 (22.5)
24 (16)
2
4 (6.6)
9 (10.1)
13 (8.7)
Type of Cardiac Event
Maternal
Mortality
Data presented
as n (%). * NotNA*
applicable
scoring system and other scoring system as well .
Data presented as n (%)
All these cardiac event was heart failure , however there
was one maternal death and this occurred postpartum in the
Table 2. Carpreg Score and Cardiac Events
Carpreg
Carpreg
Carpreg
Score 0
Score 1
Score 2
Total
Presence of Cardiac Event
Yes
1 (0.9)
3 (12.5)
4 (30.8)
8 (5.3)
No
112 (99.1)
21 (87.5)
9 (69.2)
142 (94.7)
Onset of Cardiac Event
Antepartum
1 (100)
1 (33.3)
3 (75)
5 (62.5)
Postpartum
0 (0)
2 (66.7)
1 (25)
3 (37.5)
0 (0)
1 (4.2)
1 (7.7)
2 (1.3)
Data presented as n (%)
as some patients who were discharged home may have had a
Presence of Cardiac Event
Heart Failure
Maternal mortality
Several limitations of our study also needs to be considered
Congenital
Patients went through CARPREG risk scoring and their cardiac
events were observed. The rate of cardiac complications
Total
Onset of Cardiac Event
diagnosed with heart disease for 1 year duration involving 150
patients managed by combine obstetrician and cardiologist.
specifically. As for NYHA class, it would patient and the
doctors own evaluation which may sometimes be inaccurate.
Table 4. Cardiac Events in Congenital Heart Disease
Table 1. Carpreg Score in different cardiac disease
cardiac event such as arrhythmia would be too vague as the
outcome for treated and treated event was not mentioned
Among 150 cases recruited, 61 of them were congenital heart disease
pregnant patients with heart diseases in our population.
the carpreg score must be recognized. Lesion specific
predictors need to be incorporated in the scoring and prior
Antepartum
obstruction ( mitral area <2cm, aortic area < 1.5cm or peak
reduced systemic ventricular ejection fraction ( < 40% ) .
The main finding of this study is that pregnant women with
References
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CARPREG 1 group. The patient was a 33 year old