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OPTIONAL LOGO HERE 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) OPTIONAL LOGO HERE 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. TEMPLATE DESIGN © 2008 www.PosterPresentations.com 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) 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) References primigravida who was diagnosed to have chronic rheumatic 1. Jastrow N, Meyer P, Kahiry P, et al. Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center. Int. J Cardiol 2011;151:209-213. heart disease and had severe aortic stenosis. She was 2. Ruth C., Swan L., Steera PJ. Cardiac disease in pregnancy. Curr Opinion Obstet Gynecol 2009;21:508-513. CARPREG 1 group. The patient was a 33 year old admitted from 30 weeks onwards and was on beta blockers, Onset of Cardiac Event 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 aspirin and metoprolol. The pregnancy ended up with an IUD and was delivered via caeserian section. She succumbed to the illness during postpartum. 3. Willem D., Eric B., Balci A., et al. Predictors of pregnancy complications in women with congenital heart disease. European Heart J 2010;31:21242132. 4. Samuel CS, Sermer M, Colman JM, et al. Prospective Multicenter Study of Pregnancy Outcomes in Women with Heart Disease. Am Heart Assoc Circulation 2001; 104:515-521. 5. Paul K., Ouyang DW., Fernandes SM., et al. Pregnancy Outcomes in Women with Congenital Heart Disease. Am J Heart Assoc 2006; 113:517524.