Influência da gestação na evolução clínica materno-fetal de portadoras de cardiomiopatia hipertrófica

Abstract

SummaryObjectives: To study clinical evolution of women with HCM during pregnancy; the influencing factors of gestation on natural course of HCM and the frequency of HCM in their children in early childhood.Methods: A prospective study was conducted in 35 women with HCM; there were 23 pregnant women (PG group) and 12 nonpregnant control patients (NP group), matched for age and functional class (FC). Clinical monthly evaluations were carried out and electrocardiogram and transthoracic echocardiography tests were performed. The offspring endpoints included stillbirth and prematurity rates and investigation of HCM during childhood.Results: No deaths occurred in either group. Cardiac arrhythmias were significantly (p< 0.05) more frequent in the NP group (33.3% vs 13.4%), and no differences were observed between the groups (p>0.05) in heart failure (30.3% vs 16.6%) or ischemic stroke (4.3% vs 8.3%) rates. In the PG group, required hospitalization for treatment of cardiac complication was more frequent (p=0.05) in patients with family history of HCM (71.4% vs 25.0%). Cesarean section was performed in 12 (52%) patients, for obstetrical reasons; there were 7 (30.4%) premature babies and 1 (4.3%) neonatal death. One child was clinically diagnosed as having HCM, and his genetic study identified a mutation in the beta myosin heavy chain gene, located on chromosome 14.Conclusion: Heart failure is a frequent cardiac complication in women with HCM during pregnancy, particularly in patients with family history of the disease, but this did not influence the natural course of HCM. In one child, clinical examination allowed HCM identification during early childhood.

Posicionamento da Sociedade Brasileira de Cardiologia para Gravidez e Planejamento Familiar na Mulher Portadora de Cardiopatia – 2020

“…The great variation in the rate of cardiovascular complications during pregnancy, estimated between 5% and 40%, has been attributed to the heterogeneity of the phenotype of this heart disease. [193][194][195] Although they are often asymptomatic, the most frequent complaints of pregnant women with HCM are chest pain, dyspnea, syncope, and palpitation. The factors associated with worse prognosis for pregnancy are history of HF, ventricular arrhythmia, and sudden death in the family.…”

“…From the obstetric point of view, the most frequent complications are spontaneous abortion in approximately 20% of cases and low birth weight in 10%. [193][194][195] Another important issue is the risk of transmitting the disease to the fetus, because HCM is an autosomal dominant Mendelian trait, which is also caused by mutations that encode the components of the cardiac sarcomere. 196 The complexity of this disease still does not allow for determination of its true incidence in apparently healthy newborns who do not present abnormalities on 2-dimensional echo.…”

The Challenge of Pregnancy in Women With Hypertrophic Cardiomyopathy

“…Avila et al 36 followed 23 pregnant women with HCM and 12 nonpregnant control patients with HCM matched for age and functional class according NYHA class. Seven women (30.4%) experienced HF (1 during the second trimester and 6 during the third trimester of pregnancy).…”