Impact of pregnancy on the natural history of women with hypertrophic cardiomyopathy
Abstract 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 202...
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| Veröffentlicht in: | European journal of preventive cardiology 2024-01, Vol.31 (1), p.3-10 |
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| creator | Fumagalli, Carlo Zocchi, Chiara Cappelli, Francesco Celata, Anastasia Tassetti, Luigi Sasso, Laura Zampieri, Mattia Argirò, Alessia Marchi, Alberto Targetti, Mattia Berteotti, Martina Maurizi, Niccolò Mori, Fabio Livi, Paola Baldini, Katia Tomberli, Alessia Girolami, Francesca Favilli, Silvia Mecacci, Federico Olivotto, Iacopo |
| description | Abstract
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.
Lay Summary
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 s |
| doi_str_mv | 10.1093/eurjpc/zwad257 |
| format | Article |
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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.
Lay Summary
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.
Graphical Abstract
Graphical Abstract</description><identifier>ISSN: 2047-4873</identifier><identifier>EISSN: 2047-4881</identifier><identifier>DOI: 10.1093/eurjpc/zwad257</identifier><identifier>PMID: 37531614</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Cardiomyopathy, Hypertrophic - diagnosis ; Cardiomyopathy, Hypertrophic - epidemiology ; Cardiomyopathy, Hypertrophic - therapy ; Death, Sudden, Cardiac - epidemiology ; Death, Sudden, Cardiac - etiology ; Female ; Humans ; Male ; Pregnancy ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors</subject><ispartof>European journal of preventive cardiology, 2024-01, Vol.31 (1), p.3-10</ispartof><rights>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 2023</rights><rights>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.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c329t-1d4e5dc7bfbfdfeb22343338fd40e1248559bf3e5ca745e9daa503fce86153773</citedby><cites>FETCH-LOGICAL-c329t-1d4e5dc7bfbfdfeb22343338fd40e1248559bf3e5ca745e9daa503fce86153773</cites><orcidid>0000-0002-1622-0732 ; 0000-0001-7963-5049</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37531614$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fumagalli, Carlo</creatorcontrib><creatorcontrib>Zocchi, Chiara</creatorcontrib><creatorcontrib>Cappelli, Francesco</creatorcontrib><creatorcontrib>Celata, Anastasia</creatorcontrib><creatorcontrib>Tassetti, Luigi</creatorcontrib><creatorcontrib>Sasso, Laura</creatorcontrib><creatorcontrib>Zampieri, Mattia</creatorcontrib><creatorcontrib>Argirò, Alessia</creatorcontrib><creatorcontrib>Marchi, Alberto</creatorcontrib><creatorcontrib>Targetti, Mattia</creatorcontrib><creatorcontrib>Berteotti, Martina</creatorcontrib><creatorcontrib>Maurizi, Niccolò</creatorcontrib><creatorcontrib>Mori, Fabio</creatorcontrib><creatorcontrib>Livi, Paola</creatorcontrib><creatorcontrib>Baldini, Katia</creatorcontrib><creatorcontrib>Tomberli, Alessia</creatorcontrib><creatorcontrib>Girolami, Francesca</creatorcontrib><creatorcontrib>Favilli, Silvia</creatorcontrib><creatorcontrib>Mecacci, Federico</creatorcontrib><creatorcontrib>Olivotto, Iacopo</creatorcontrib><title>Impact of pregnancy on the natural history of women with hypertrophic cardiomyopathy</title><title>European journal of preventive cardiology</title><addtitle>Eur J Prev Cardiol</addtitle><description>Abstract
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.
Lay Summary
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.
Graphical Abstract
Graphical Abstract</description><subject>Cardiomyopathy, Hypertrophic - diagnosis</subject><subject>Cardiomyopathy, Hypertrophic - epidemiology</subject><subject>Cardiomyopathy, Hypertrophic - therapy</subject><subject>Death, Sudden, Cardiac - epidemiology</subject><subject>Death, Sudden, Cardiac - etiology</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Pregnancy</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><issn>2047-4873</issn><issn>2047-4881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkD1PwzAQQC0EolXpyog8wpA2_qrTEVV8VKrEUubIcc4kVRMb21EVfj2pWrpyy93w7g0PoXuSzki6ZHPo_M7p-c9BlVTIKzSmKZcJzzJyfbklG6FpCLt0mEVKaZbdohGTgpEF4WO0XTdO6Yitwc7DV6ta3WPb4lgBblXsvNrjqg7R-v7IHGwDLT7UscJV78BHb11Va6yVL2vb9NapWPV36MaofYDpeU_Q5-vLdvWebD7e1qvnTaIZXcaElBxEqWVhClMaKChlnDGWmZKnQCjPhFgWhoHQSnIBy1IpkTKjIVsQwaRkE_R48jpvvzsIMW_qoGG_Vy3YLuQ042Ih5NBmQGcnVHsbggeTO183yvc5SfNjzPwUMz_HHB4ezu6uaKC84H_pBuDpBNjO_Sf7BbFWgoE</recordid><startdate>20240105</startdate><enddate>20240105</enddate><creator>Fumagalli, Carlo</creator><creator>Zocchi, Chiara</creator><creator>Cappelli, Francesco</creator><creator>Celata, Anastasia</creator><creator>Tassetti, Luigi</creator><creator>Sasso, Laura</creator><creator>Zampieri, Mattia</creator><creator>Argirò, Alessia</creator><creator>Marchi, Alberto</creator><creator>Targetti, Mattia</creator><creator>Berteotti, Martina</creator><creator>Maurizi, Niccolò</creator><creator>Mori, Fabio</creator><creator>Livi, Paola</creator><creator>Baldini, Katia</creator><creator>Tomberli, Alessia</creator><creator>Girolami, Francesca</creator><creator>Favilli, Silvia</creator><creator>Mecacci, Federico</creator><creator>Olivotto, Iacopo</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1622-0732</orcidid><orcidid>https://orcid.org/0000-0001-7963-5049</orcidid></search><sort><creationdate>20240105</creationdate><title>Impact of pregnancy on the natural history of women with hypertrophic cardiomyopathy</title><author>Fumagalli, Carlo ; Zocchi, Chiara ; Cappelli, Francesco ; Celata, Anastasia ; Tassetti, Luigi ; Sasso, Laura ; Zampieri, Mattia ; Argirò, Alessia ; Marchi, Alberto ; Targetti, Mattia ; Berteotti, Martina ; Maurizi, Niccolò ; Mori, Fabio ; Livi, Paola ; Baldini, Katia ; Tomberli, Alessia ; Girolami, Francesca ; Favilli, Silvia ; Mecacci, Federico ; Olivotto, Iacopo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c329t-1d4e5dc7bfbfdfeb22343338fd40e1248559bf3e5ca745e9daa503fce86153773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Cardiomyopathy, Hypertrophic - diagnosis</topic><topic>Cardiomyopathy, Hypertrophic - epidemiology</topic><topic>Cardiomyopathy, Hypertrophic - therapy</topic><topic>Death, Sudden, Cardiac - epidemiology</topic><topic>Death, Sudden, Cardiac - etiology</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Pregnancy</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fumagalli, Carlo</creatorcontrib><creatorcontrib>Zocchi, Chiara</creatorcontrib><creatorcontrib>Cappelli, Francesco</creatorcontrib><creatorcontrib>Celata, Anastasia</creatorcontrib><creatorcontrib>Tassetti, Luigi</creatorcontrib><creatorcontrib>Sasso, Laura</creatorcontrib><creatorcontrib>Zampieri, Mattia</creatorcontrib><creatorcontrib>Argirò, Alessia</creatorcontrib><creatorcontrib>Marchi, Alberto</creatorcontrib><creatorcontrib>Targetti, Mattia</creatorcontrib><creatorcontrib>Berteotti, Martina</creatorcontrib><creatorcontrib>Maurizi, Niccolò</creatorcontrib><creatorcontrib>Mori, Fabio</creatorcontrib><creatorcontrib>Livi, Paola</creatorcontrib><creatorcontrib>Baldini, Katia</creatorcontrib><creatorcontrib>Tomberli, Alessia</creatorcontrib><creatorcontrib>Girolami, Francesca</creatorcontrib><creatorcontrib>Favilli, Silvia</creatorcontrib><creatorcontrib>Mecacci, Federico</creatorcontrib><creatorcontrib>Olivotto, Iacopo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of preventive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fumagalli, Carlo</au><au>Zocchi, Chiara</au><au>Cappelli, Francesco</au><au>Celata, Anastasia</au><au>Tassetti, Luigi</au><au>Sasso, Laura</au><au>Zampieri, Mattia</au><au>Argirò, Alessia</au><au>Marchi, Alberto</au><au>Targetti, Mattia</au><au>Berteotti, Martina</au><au>Maurizi, Niccolò</au><au>Mori, Fabio</au><au>Livi, Paola</au><au>Baldini, Katia</au><au>Tomberli, Alessia</au><au>Girolami, Francesca</au><au>Favilli, Silvia</au><au>Mecacci, Federico</au><au>Olivotto, Iacopo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of pregnancy on the natural history of women with hypertrophic cardiomyopathy</atitle><jtitle>European journal of preventive cardiology</jtitle><addtitle>Eur J Prev Cardiol</addtitle><date>2024-01-05</date><risdate>2024</risdate><volume>31</volume><issue>1</issue><spage>3</spage><epage>10</epage><pages>3-10</pages><issn>2047-4873</issn><eissn>2047-4881</eissn><abstract>Abstract
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.
Lay Summary
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.
Graphical Abstract
Graphical Abstract</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>37531614</pmid><doi>10.1093/eurjpc/zwad257</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-1622-0732</orcidid><orcidid>https://orcid.org/0000-0001-7963-5049</orcidid></addata></record> |
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| ispartof | European journal of preventive cardiology, 2024-01, Vol.31 (1), p.3-10 |
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| language | eng |
| recordid | cdi_proquest_miscellaneous_2845657257 |
| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Cardiomyopathy, Hypertrophic - diagnosis Cardiomyopathy, Hypertrophic - epidemiology Cardiomyopathy, Hypertrophic - therapy Death, Sudden, Cardiac - epidemiology Death, Sudden, Cardiac - etiology Female Humans Male Pregnancy Proportional Hazards Models Retrospective Studies Risk Factors |
| title | Impact of pregnancy on the natural history of women with hypertrophic cardiomyopathy |
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