PMID- 37531614
OWN - NLM
STAT- MEDLINE
DCOM- 20240108
LR  - 20240108
IS  - 2047-4881 (Electronic)
IS  - 2047-4873 (Linking)
VI  - 31
IP  - 1
DP  - 2024 Jan 5
TI  - Impact of pregnancy on the natural history of women with hypertrophic 
      cardiomyopathy.
PG  - 3-10
LID - 10.1093/eurjpc/zwad257 [doi]
AB  - AIMS: Whether pregnancy is a modifier of the long-term course and outcome of 
      women with hypertrophic cardiomyopathy (HCM) is unknown. We assessed the 
      association of pregnancy with long-term outcomes in HCM women. METHODS AND 
      RESULTS: Retrospective evaluation of women with HCM from 1970 to 2021. Only women 
      with pregnancy-related information (pregnancy present or absent) and a follow-up 
      period lasting >/=1 year were included. The peri-partum period was defined as -1 to 
      6 months after delivery. The primary endpoint was a composite for major adverse 
      cardiovascular events [MACE: cardiovascular death, sudden cardiac death, 
      appropriate defibrillator shock and heart failure (HF) progression]. Overall, 379 
      (58%) women were included. There were 432 pregnancies in 242 (63%) patients. In 
      29 (7.6%) cases, pregnancies (n = 39) occurred after HCM diagnosis. Among these, 
      three carrying likely pathogenic sarcomeric variants suffered MACEs in the 
      peri-partum period. At 10 +/- 9 years of follow-up, age at diagnosis [hazard ratio 
      (HR) 1.034, 95% confidence interval (CI) 1.018-1.050, P < 0.001] and New York 
      Heart Association (NYHA) class (II vs. I: HR 1.944, 95% CI 0.896-4.218; III vs. 
      I: HR 5.291, 95% CI 2.392-11.705, P < 0.001) were associated with MACE. 
      Conversely, pregnancy was associated with reduced risk (HR 0.605; 95% CI 
      0.380-0.963, P = 0.034). Among women with pregnancy, multiple occurrences did not 
      modify risk. CONCLUSIONS: Pregnancy is not a modifier of long-term outcome in 
      women with HCM and mostly occurs before a cardiac diagnosis. Most patients 
      tolerate pregnancy well and do not show a survival disadvantage compared to women 
      without. Pregnancy should not be discouraged, except in the presence of severe HF 
      symptoms or high-risk features.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      European Society of Cardiology. All rights reserved. For permissions, please 
      e-mail: journals.permissions@oup.com.
FAU - Fumagalli, Carlo
AU  - Fumagalli C
AUID- ORCID: 0000-0001-7963-5049
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
AD  - Department of Advanced Medical and Surgical Sciences, University of Campania 
      'Luigi Vanvitelli', Piazza Miraglia, 2, Naples 80138, Italy.
FAU - Zocchi, Chiara
AU  - Zocchi C
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Cappelli, Francesco
AU  - Cappelli F
AUID- ORCID: 0000-0002-1622-0732
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Celata, Anastasia
AU  - Celata A
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Tassetti, Luigi
AU  - Tassetti L
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Sasso, Laura
AU  - Sasso L
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Zampieri, Mattia
AU  - Zampieri M
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Argiro, Alessia
AU  - Argiro A
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Marchi, Alberto
AU  - Marchi A
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Targetti, Mattia
AU  - Targetti M
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Berteotti, Martina
AU  - Berteotti M
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Maurizi, Niccolo
AU  - Maurizi N
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Mori, Fabio
AU  - Mori F
AD  - Obstetrics and Gynecology Unit, Careggi University Hospital, Florence, Italy.
FAU - Livi, Paola
AU  - Livi P
AD  - Obstetrics and Gynecology Unit, Careggi University Hospital, Florence, Italy.
FAU - Baldini, Katia
AU  - Baldini K
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Tomberli, Alessia
AU  - Tomberli A
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
FAU - Girolami, Francesca
AU  - Girolami F
AD  - Pediatric Cardiology, Meyer Children's University Hospital, Florence, Italy.
FAU - Favilli, Silvia
AU  - Favilli S
AD  - Pediatric Cardiology, Meyer Children's University Hospital, Florence, Italy.
FAU - Mecacci, Federico
AU  - Mecacci F
AD  - Obstetrics and Gynecology Unit, Careggi University Hospital, Florence, Italy.
FAU - Olivotto, Iacopo
AU  - Olivotto I
AD  - Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 
      50134, Italy.
AD  - Pediatric Cardiology, Meyer Children's University Hospital, Florence, Italy.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur J Prev Cardiol
JT  - European journal of preventive cardiology
JID - 101564430
SB  - IM
MH  - Pregnancy
MH  - Humans
MH  - Female
MH  - Male
MH  - Retrospective Studies
MH  - Risk Factors
MH  - *Cardiomyopathy, Hypertrophic/diagnosis/epidemiology/therapy
MH  - Death, Sudden, Cardiac/epidemiology/etiology
MH  - Proportional Hazards Models
OAB - Hypertrophic cardiomyopathy (HCM) is the most common genetic disorder of the 
      myocardium and is characterized by important gender-related differences: women 
      are typically 5 years older than men at diagnosis, over half are diagnosed >50 
      years of age and consistently show greater propensity than men for heart failure 
      (HF)-related complications and adverse outcome. Whether pregnancy is a modifier 
      of the long-term course and outcome of women with HCM is unknown. In this study, 
      pregnancy was not a modifier of long-term outcome in women with HCM. In 
      particular: At 10 +/- 7 years, most patients tolerated pregnancy well and did not 
      show a survival disadvantage compared to women without pregnancies. Only baseline 
      heart failure symptoms and age were associated with adverse outcome.Pregnancy 
      should not be discouraged, except in the presence of severe HF symptoms or 
      high-risk features. Nevertheless, cardio-obstetric counselling and close 
      supervision are key in all instances, particularly in the peri-partum period.
OABL- eng
OTO - NOTNLM
OT  - Gender-medicine
OT  - HCM
OT  - Heart failure
OT  - Pregnancy
OT  - Prognosis
COIS- Conflict of interest: The Authors report no conflict of interest for the present 
      work.
EDAT- 2023/08/02 19:15
MHDA- 2024/01/08 06:43
CRDT- 2023/08/02 16:42
PHST- 2023/04/28 00:00 [received]
PHST- 2023/07/26 00:00 [revised]
PHST- 2023/07/31 00:00 [accepted]
PHST- 2024/01/08 06:43 [medline]
PHST- 2023/08/02 19:15 [pubmed]
PHST- 2023/08/02 16:42 [entrez]
AID - 7235873 [pii]
AID - 10.1093/eurjpc/zwad257 [doi]
PST - ppublish
SO  - Eur J Prev Cardiol. 2024 Jan 5;31(1):3-10. doi: 10.1093/eurjpc/zwad257.