S Goland1, I M van Hagen2, G Elbaz-Greener3, U Elkayam4, A Shotan5, W M Merz6, S C Enar7, I R Gaisin8, P G Pieper9, M R Johnson10, R Hall11, A Blatt3, J W Roos-Hesselink2,12. 1. Heart Institute, Kaplan Medical Center, Rehovot, affiliated to the Hebrew University, Jerusalem, Israel. 2. Department of cardiology, Erasmus MC, Ba583a, POBox 2040, 3000 CA Rotterdam, The Netherlands. 3. Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. University of Southern California, Los Angeles, California, USA. 5. Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel. 6. Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Germany. 7. Cardiology, Turkiye Hospital, Istanbul, Turkey. 8. Izhevsk State Medical Academy, Russian Federation. 9. University Medical Center Groningen, University of Groningen, Netherlands. 10. Department of obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK. 11. Department of cardiology, Norwich Medical school, University of East Anglia, Norwich, UK. 12. Fellow of the ESC, Sophia Antipolis Cedex, France.
Abstract
AIMS: We report the maternal and foetal outcomes at birth and after 6 months in a cohort of pregnant women with hypertrophic cardiomyopathy (HCM). Although most women with HCM tolerate pregnancy well, there is an increased risk of obstetric and cardiovascular complications. METHODS AND RESULTS: All pregnant women with HCM entered into the prospective worldwide Registry of Pregnancy and Cardiac disease (ROPAC) were included in this analysis. The primary endpoint was a major adverse cardiovascular event (MACE), which included death, heart failure (HF), thrombo-embolic event, and arrhythmia. Baseline and outcome data were analysed and compared for patients with MACE vs. without MACE and for patients with obstructive HCM vs. non-obstructive HCM. Sixty pregnant women (mean age 30.4 ± 6.0 years) with HCM (41.7% obstructive) were included. No maternal mortality occurred in this cohort. In 14 (23%) patients at least one MACE occurred: 9 (15.0%) HF and 7 (12%) an arrhythmia (6 ventricular and 1 atrial fibrillation). MACE occurred most commonly during the 3rd trimester and postpartum period. In total, 3 (5.0%) women experienced foetal loss. Women with MACE had a higher rate of emergency Caesarean delivery for cardiac reasons (21.4% vs. 0%, P = 0.01). No significant differences in pregnancy outcome were found between women with obstructive and non-obstructive HCM. NYHA functional class of ≥II and signs of HF before pregnancy, were associated with MACE. CONCLUSION: Although most women with HCM tolerated pregnancy well, cardiovascular complications were not uncommon and predicted by pre-pregnancy status facilitating pre-pregnancy counselling and targeted antenatal care. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We report the maternal and foetal outcomes at birth and after 6 months in a cohort of pregnant women with hypertrophic cardiomyopathy (HCM). Although most women with HCM tolerate pregnancy well, there is an increased risk of obstetric and cardiovascular complications. METHODS AND RESULTS: All pregnant women with HCM entered into the prospective worldwide Registry of Pregnancy and Cardiac disease (ROPAC) were included in this analysis. The primary endpoint was a major adverse cardiovascular event (MACE), which included death, heart failure (HF), thrombo-embolic event, and arrhythmia. Baseline and outcome data were analysed and compared for patients with MACE vs. without MACE and for patients with obstructive HCM vs. non-obstructive HCM. Sixty pregnant women (mean age 30.4 ± 6.0 years) with HCM (41.7% obstructive) were included. No maternal mortality occurred in this cohort. In 14 (23%) patients at least one MACE occurred: 9 (15.0%) HF and 7 (12%) an arrhythmia (6 ventricular and 1 atrial fibrillation). MACE occurred most commonly during the 3rd trimester and postpartum period. In total, 3 (5.0%) women experienced foetal loss. Women with MACE had a higher rate of emergency Caesarean delivery for cardiac reasons (21.4% vs. 0%, P = 0.01). No significant differences in pregnancy outcome were found between women with obstructive and non-obstructive HCM. NYHA functional class of ≥II and signs of HF before pregnancy, were associated with MACE. CONCLUSION: Although most women with HCM tolerated pregnancy well, cardiovascular complications were not uncommon and predicted by pre-pregnancy status facilitating pre-pregnancy counselling and targeted antenatal care. Published on behalf of the European Society of Cardiology. All rights reserved.
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