Abstract 10057: Predicting Cardiac Complications during Pregnancy in Women with Congenital Heart Disease
Background: Women with congenital heart disease (CHD) have an increased risk of complications during pregnancy including heart failure (HF), arrhythmias, and thromboembolic events (TEC). In 2010, Drenthen proposed a maternal risk score (MRS) to predict maternal complications, but this score has yet to be verified in a prospective population.
Methods: We reviewed 78 pregnancies in 70 women, mean age 26.97 ± 5.71 years (range 17.12 - 41.8). CHD defect classification was simple in 5 (6.4%), moderate in 48 (61.5%), complex in 20 (25.6%), and other in 5 (6.4%) with mean MRS of 1.45 (range 0- 9).
Results: Maternal cardiac complications defined as clinically significant arrhythmia, HF, or TEC occurred in 17 pregnancies (28.8%). Risk distribution and maternal complications rates are shown in the table. There was a statistically significant trend towards a higher rate of adverse cardiac events with a higher MRS (p = 0.023). All complications in two lowest risk categories (0-1.50) were arrhythmias. A logistic model (Calculated RS) created to predict cardiac complications using additional variables improved the predictability of the model (see figure). Due to the small number of complications, the difference in area under the ROC curve did not reach statistical significance.
Conclusion: In this high-risk cohort, the current risk score underestimated the rate of maternal cardiac complications, particularly arrhythmias in patients with a lower risk scores. The addition of CHD classification, aortic and pulmonary valve regurgitation, and ventricular function in a logistic model improves predictability of the risk score. Further validation in a larger population is needed.
- © 2012 by American Heart Association, Inc.