Pregnancy in hypertrophic cardiomyopathy: New data, old questions

Abstract

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease, affecting approximately 1:500 of the adult population [ [1] Maron B.J. Desai M.Y. Nishimura R.A. et al. Management of Hypertrophic Cardiomyopathy: JACC state-of-the-art review. J. Am. Coll. Cardiol. 2022 Feb 1; 79: 390-414 Crossref PubMed Scopus (12) Google Scholar ]. The past decades witnessed an exponential growth of knowledge about HCM. It is now clear that HCM can have a widely variable clinical course, ranging from a lifelong asymptomatic state to a highly symptomatic condition complicated by heart failure (HF), arrhythmias and sudden death [ [1] Maron B.J. Desai M.Y. Nishimura R.A. et al. Management of Hypertrophic Cardiomyopathy: JACC state-of-the-art review. J. Am. Coll. Cardiol. 2022 Feb 1; 79: 390-414 Crossref PubMed Scopus (12) Google Scholar , [2] Antunes M.O. Scudeler T.L. Hypertrophic cardiomyopathy. Int. J. Cardiol. Heart Vasc. 2020 Mar 25; 27 (Erratum in: Int J Cardiol Heart Vasc. 2020 Nov 18;31:100676): 100503https://doi.org/10.1016/j.ijcha.2020.100503 Crossref PubMed Scopus (24) Google Scholar ]. With the improved clinical awareness of the disease and the deployment of familial screening, cardiologists will increasingly face the management of HCM women of childbearing age. HCM is now “60 years-old” since the original pathologic description [ [1] Maron B.J. Desai M.Y. Nishimura R.A. et al. Management of Hypertrophic Cardiomyopathy: JACC state-of-the-art review. J. Am. Coll. Cardiol. 2022 Feb 1; 79: 390-414 Crossref PubMed Scopus (12) Google Scholar ] but despite its “age” and high prevalence, few studies [ 3 Autore C. Conte M.R. Piccininno M. et al. Risk associated with pregnancy in hypertrophic cardiomyopathy. J. Am. Coll. Cardiol. 2002 Nov 20; 40: 1864-1869 Crossref PubMed Scopus (140) Google Scholar , 4 Goland S. van Hagen I.M. Elbaz-Greener G. et al. Pregnancy in women with hypertrophic cardiomyopathy: data from the European Society of Cardiology initiated registry of pregnancy and cardiac disease (ROPAC). Eur. Heart J. 2017 Sep 14; 38: 2683-2690 Crossref PubMed Scopus (54) Google Scholar , 5 Thaman R. Varnava A. Hamid M.S. et al. Pregnancy related complications in women with hypertrophic cardiomyopathy. Heart. 2003 Jul; 89: 752-756 Crossref PubMed Scopus (103) Google Scholar , 6 Musumeci M.B. Spirito P. Conte M.R. et al. Clinical course of pregnancy and long-term follow-up after delivery in hypertrophic cardiomyopathy. J. Am. Coll. Cardiol. 2021 Mar 9; 77: 1262-1264 Crossref PubMed Scopus (2) Google Scholar , 7 Schinkel A.F. Pregnancy in women with hypertrophic cardiomyopathy. Cardiol. Rev. 2014 Sep-Oct; 22: 217-222 Crossref PubMed Scopus (29) Google Scholar ] have systematically investigated the clinical course and maternal and fetal outcomes of pregnant HCM patients. All the studies currently available have some source of bias and/or limitations, due to the inherent complexity of the topic [ [3] Autore C. Conte M.R. Piccininno M. et al. Risk associated with pregnancy in hypertrophic cardiomyopathy. J. Am. Coll. Cardiol. 2002 Nov 20; 40: 1864-1869 Crossref PubMed Scopus (140) Google Scholar ]. Retrospective investigations have the selection bias of excluding patients who died during pregnancy, before HCM diagnosis or first medical evaluation. Prospective studies are usually limited by the small sample size and the low rate of cardiac events. Moreover, a prospective study would imply the major bias of selectively including patients judged “fit enough” to embark into a pregnancy. Outcomes of pregnancy in women with hypertrophic cardiomyopathy: A systematic reviewInternational Journal of CardiologyVol. 359PreviewHypertrophic cardiomyopathy (HCM) is a genetic disorder that can be complicated by heart failure and sudden cardiac death. Pregnancy causes hemodynamic changes, which may be deleterious in patients with HCM. Existing cohort studies, analyzing maternal and fetal outcomes of pregnant HCM patients, are limited by small sample sizes. We performed a systematic review of maternal and fetal outcomes of pregnancy in patients with HCM. Full-Text PDF