CARPREG II Score Calculator (Cardiac Disease in Pregnancy Risk Index)

CARPREG II Score stratifies risk of cardiovascular events in pregnant women based on 10 cardiac risk predictors.

Refer to the text below the calculator for more information on CARPREG II and its usage.

The likelihood of complications for both mother and fetus is heightened in pregnant women with heart conditions. The CARPREG II risk stratification index assists healthcare providers in minimizing negative outcomes by informing clinical decisions and managing the care of pregnant women.

CAPREG II has been used in studies to evaluate cardiac risk stratification of pregnant women suffering from cardiomyopathies and also to determine its validity for being used to can identify women at highest risk for long-term cardiovascular events post-pregnancy.

CARPREG II score Primary cardiac event risk
1 point 5%
2 points 10%
3 points 15%
4 points 22%
≥ 5 points 41%

1Prior cardiac events or arrhythmias
2Baseline NYHA 3-4 or cyanosis
3Mechanical valve
4Systemic ventricular dysfunction LVEF <55%
5High-risk valve disease or left ventricular outflow tract obstruction* * (aortic valve area <1.5cm2, subaortic gradient >30, or moderate to severe mitral regurgitation, mitral stenosis <2.0 cm2)
6Pulmonary hypertension, RVSP >49mmHG
7High-risk aortopathy
8Coronary artery disease
9No prior cardiac intervention
10Late pregnancy assessment
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CARPREG II Score explained

Risk of maternal-fetal complications is increased in women with cardiac pathology. The CARPREG II risk stratification index helps healthcare professionals reduce adverse outcomes by guiding clinical decisions and management of the pregnant woman.

CARPREG II is consists of a collection of 10 cardiac risk predictors found to be relevant in the case of pregnant women, their presence is scored with a number of points which are then added together to produce a final result.

Cardiac Risk Predictors Points
Prior cardiac events or arrhythmias 3
Baseline NYHA 3-4 or cyanosis 3
Mechanical valve 3
Systemic ventricular dysfunction LVEF <55% 2
High-risk valve disease or left ventricular outflow tract obstruction (aortic valve area <1.5cm2, subaortic gradient >30, or moderate to severe mitral regurgitation, mitral stenosis < 2.0 cm2) 2
Pulmonary hypertension, RVSP >49 mmHg 2
High-risk aortopathy 2
Coronary artery disease 2
No prior cardiac intervention 1
Late pregnancy assessment 1

Scores can be interpreted as follows:

CARPREG II score Primary cardiac event risk
1 point 5%
2 points 10%
3 points 15%
4 points 22%
≥ 5 points 41%

Following pregnancy, women with heart disease continue to be at high risk for adverse long-term cardiovascular outcomes. Current pregnancy risk prediction tools, such as the CARPREG II can identify women at highest risk for long-term cardiovascular events.

CARPREG II has also been validated in a sample of pregnant women with inherited cardiomyopathy, which is a condition that carries a recognised high risk of maternal cardiovascular complications.


About the original study

CARPREG II was established following a validation and comparison study of a risk prediction model in a prospective cohort of pregnant women with heart disease assessed between 2016 and 2019.

In a cohort of 328 pregnant women (27±7 years), 33% (n=110) had congenital heart disease, followed by arrhythmias in 30% (n=98), valvular pathologies in 14% (n=46) and cardiomyopathies in 9% (n=29).

A cardiac event occurred in 15% of cases, with left heart failure (5.3%) and arrhythmias (2.3%) being the most frequent. The frequency of maternal death of cardiac origin was 1.6%. Neonatal outcomes occurred in 37% of gestations (preterm delivery (16%) and low weight for gestational age (8.4%)) and obstetric events in 12.5%: pregnancy-induced hypertension (9%) and postpartum haemorrhage (2.3%).

NYHA functional class III-IV or cyanosis (OR 12 95% CI 3.1 - 46.4) and left ventricular dysfunction (LVEF <55%) (OR 3 95% CI 1 - 10.9) were the most statistically significant risk predictors.

The CARPREG II risk model proved a good ability to stratify the risk of adverse cardiac outcomes in pregnant women with heart disease.



Original reference

Silversides CK, Grewal J, Mason J, Sermer M, Kiess M, Rychel V, Wald RM, Colman JM, Siu SC. Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study. J Am Coll Cardiol. 2018; 71(21):2419-2430.


D Botero, J Senior, J Velasquez, J Gandara, A Zapata, E Holguin, C Jaramillo, J Ferreira, E Munoz, Validation of the CARPREG II risk stratification model and the WHOm scale in pregnant women with heart disease, European Heart Journal, Volume 42, Issue Supplement_1, October 2021.

Wallet T, Legrand L, Isnard R, Gandjbakhch E, Pousset F, Proukhnitzky J, Dommergues M, Nizard J, Charron P. Pregnancy and cardiac maternal outcomes in women with inherited cardiomyopathy: interest of the CARPREG II risk score. ESC Heart Fail. 2024. doi: 10.1002/ehf2.14694.

Other references

Siu SC, Lee DS, Rashid M, Fang J, Austin PC, Silversides CK. Long-Term Cardiovascular Outcomes After Pregnancy in Women With Heart Disease. J Am Heart Assoc. 2021 Jun;10(11):e020584.

Specialty: Cardiology

Objective: Risk stratification

Type: Score

No. Of Items: 10

Year Of Study: 2018

Abbreviation: CARPREG II

Article By: Denise Nedea

Published On: April 22, 2024

Last Checked: April 22, 2024

Next Review: April 22, 2029