Güner Ahmet, Candan Özkan, Kahraman Serkan, Güner Ezgi Gültekin, Özcan Sevgi, Gürsoy Mustafa Ozan, Kalçık Macit, Uslu Abdulkadir, Dönmez Esra, Zehir Regayip, Ertürk Mehmet, Yıldız Mustafa, Özkan Mehmet
Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Turgut Özal Bulvari No:11, 34303, Kucukcekmece, Istanbul, Turkey.
Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
Herz. 2023 Mar;48(2):141-151. doi: 10.1007/s00059-022-05108-8. Epub 2022 Apr 1.
The effect of physiological circulatory changes during pregnancy on hypertrophic cardiomyopathy (HCM) has been reported with limited data. This study aimed to provide information regarding outcomes of pregnant women with HCM and to identify predictors of major adverse cardiac event (MACE).
A total of 45 pregnancies with HCM were retrospectively reviewed. The primary endpoint was a MACE that occurred within an 8‑week period after delivery, including maternal death, heart failure (HF), syncope, and malignant ventricular arrhythmias (VAs). Baseline and outcome data were analyzed for all patients. Patients with and without MACE were compared, and patients with obstructive HCM were compared with those who had non-obstructive HCM. The study population was divided into two subgroups of patients having or not having an implantable cardioverter defibrillator implantation (ICD).
At least one MACE occurred in 11 patients (24.4%); six patients developed HF (13.3%), six had a ventricular tachyarrhythmia (13.3%), and two had syncope (4.4%). New York Heart Association functional class of ≥ II, presence of HF signs before pregnancy, increased left ventricular outflow tract (LVOT) gradient were significantly associated with MACE. Fatal VAs were seen during pregnancy in one of five HCM patients with ICD. In the ROC curve analysis, an LVOT gradient higher than 53.5 mm Hg predicted the presence of MACE with a sensitivity of 90.9% and a specificity of 73.5%. This study is the largest series in the literature representing pregnant women who had HCM and ICD.
The current data suggest that HF and high LVOT gradients are important risk factors for the development of cardiac complications.
关于孕期生理循环变化对肥厚型心肌病（HCM）影响的数据报道有限。本研究旨在提供有关HCM孕妇结局的信息，并确定主要不良心脏事件（MACE）的预测因素。
回顾性分析了45例患有HCM的妊娠病例。主要终点是产后8周内发生的MACE，包括孕产妇死亡、心力衰竭（HF）、晕厥和恶性室性心律失常（VAs）。分析了所有患者的基线和结局数据。比较了发生和未发生MACE的患者，以及梗阻性HCM患者与非梗阻性HCM患者。研究人群分为植入或未植入植入式心律转复除颤器（ICD）的两个亚组。
11例患者（24.4%）至少发生了1次MACE；6例患者发生HF（13.3%），6例发生室性快速心律失常（13.3%），2例发生晕厥（4.4%）。纽约心脏协会功能分级≥II级、妊娠前存在HF体征、左心室流出道（LVOT）梯度增加与MACE显著相关。5例植入ICD的HCM患者中有1例在孕期发生了致命性VAs。在ROC曲线分析中，LVOT梯度高于53.5 mmHg预测MACE的存在，敏感性为90.9%，特异性为73.5%。本研究是文献中代表患有HCM和ICD的孕妇的最大系列研究。
目前的数据表明，HF和高LVOT梯度是发生心脏并发症的重要危险因素。
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