ArticleInternational journal of cardiology. Congenital heart disease2024
Predicting cardiac and pregnancy outcomes in women with adult congenital heart disease using the Anatomic and Physiological (AP) Classification System: How much does physiology matter?
Article in International journal of cardiology. Congenital heart disease, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Maternal cardiac risk stratification in contemporary practice: external validation of mWHO, CARPREG II and ZAHARA in a 14-year tertiary cohort.Open heart · 2026Article
- Sensitivity of Administrative Coding for Heart Disease in Pregnancy.Clinical epidemiology · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Pregnancy in women with congenital heart disease (CHD) is associated with an increased risk of adverse maternal and fetal events. Despite the physiological impact of CHD on pregnancy, current risk stratification scores primarily consider anatomical lesions. We assessed the performance of the novel American Heart Association Anatomic and Physiological (AP) classification system in predicting adverse maternal cardiac, obstetric and fetal events, and compared it with established risk models. Methods: This retrospective cohort study enrolled pregnant women with CHD managed by the Westmead Hospital high-risk pregnancy team. Preconception risk stratification scores (AP classification, mWHO classification, CARPREG II and ZAHARA scores) were retrospectively assigned to each pregnancy by an adult CHD cardiologist and compared with the primary outcome measures, which were maternal cardiac, obstetric and fetal complications. Results: We analysed 176 pregnancies in 120 women with CHD. Maternal cardiac risk significantly increased between AP class 2 and 3 (p = 0.001). Within class 3, higher physiological status correlated with maternal cardiac events (p < 0.001). Increasing AP severity correlated with lower fetal birthweight percentiles (p = 0.003). The AP classification was similar to mWHO at predicting maternal cardiac outcomes (AUC 0.787 vs 0.777, p < 0.001), but the CARPREG II (AUC 0.852, p < 0.001) and ZAHARA scores (AUC 0.864, p < 0.001) had higher discriminatory ability within our cohort. Conclusion: The AP classification system shows non-inferior preconception maternal cardiac risk prediction compared to current validated scores. Consideration of physiological status has additive predictive value in the most complex patients (Stage III). Prospective, multicenter studies are required for further validation for preconception risk estimation.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.