Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China.
Niger J Clin Pract. 2024 Jul 1;27(7):865-872. doi: 10.4103/njcp.njcp_62_24. Epub 2024 Jul 27.
Hypertrophic cardiomyopathy (HCM) is a common inherited genetic cardiac disease during pregnancy. Studies of risk factors are of great significance for maternal and fetal outcomes.
The aim of the study was to identify predictive risk factors for cardiac complications in pregnant women with HCM.
One hundred patients with HCM who delivered at the Shanghai obstetrical cardiology intensive care center between January 2000 and December 2022 were retrospectively reviewed. A logistic regression model was used to identify independent risk factors for cardiac complications.
Twenty-one cases were obstructive HCM (21%), 16 with cardiac function grade I and 5 with grade II; 79 cases were non-obstructive HCM (79%), 67 with cardiac function grade I, 11 with grade II, and 1 with grade III. Ninety-one cases had abnormal electrocardiogram (ECG) (91%), mainly with ST-T changes (77%). The average interventricular septum was 19.39 ± 6.13 mm by echocardiography (21.75 ± 5.86 mm for obstructive HCM and 18.73 ± 6.08 mm for non-obstructive HCM). The main cardiac complications were maternal death (n = 2, 2%), heart failure (n = 7, 7%), and sustained ventricular tachyarrhythmia (n = 1, 1%). Cardiac complications occur commonly during the third trimester and postpartum period. Three independent risk factors to predict cardiac complications in pregnant women with HCM were obstructive HCM (P = 0.036), New York Heart Association (NYHA) class ≥II (P = 0.022), and previous history of syncope (P = 0.037).
HCM increases the risk of maternal death, heart failure, and malignant arrhythmia. More attention should be given to risk assessment and pregnancy management. Early detection of risk factors can reduce the incidence of maternal mortality and cardiac complications.
肥厚型心肌病（HCM）是妊娠期间常见的遗传性心脏病。对危险因素的研究对母婴结局具有重要意义。
本研究旨在确定 HCM 孕妇心脏并发症的预测性危险因素。
回顾性分析 2000 年 1 月至 2022 年 12 月在上海产科心脏病重症监护中心分娩的 100 例 HCM 患者。采用 logistic 回归模型识别心脏并发症的独立危险因素。
21 例为梗阻性 HCM（21%），16 例心功能Ⅰ级，5 例心功能Ⅱ级；79 例为非梗阻性 HCM（79%），67 例心功能Ⅰ级，11 例心功能Ⅱ级，1 例心功能Ⅲ级。91 例心电图（ECG）异常（91%），主要表现为 ST-T 改变（77%）。超声心动图显示室间隔平均厚度为 19.39±6.13mm（梗阻性 HCM 为 21.75±5.86mm，非梗阻性 HCM 为 18.73±6.08mm）。主要心脏并发症为孕产妇死亡（n=2，2%）、心力衰竭（n=7，7%）和持续性室性心动过速（n=1，1%）。心脏并发症常见于孕晚期和产后。预测 HCM 孕妇心脏并发症的 3 个独立危险因素为梗阻性 HCM（P=0.036）、纽约心脏协会（NYHA）心功能分级≥Ⅱ级（P=0.022）和晕厥史（P=0.037）。
HCM 增加了孕产妇死亡、心力衰竭和恶性心律失常的风险。应更加重视风险评估和妊娠管理。早期发现危险因素可降低孕产妇死亡率和心脏并发症的发生率。
