Comparative characteristics of pregnancy course in women with hypertrophic cardiomyopathy: data from the perinatal center registry of the Almazov National Medical Research Centre

Objective. To compare clinical and anamnestic data and echocardiographic parameters in patients with obstructive and non-obstructive forms of hypertrophic cardiomyopathy (HCM) examined at a specialized centre for pregnancy and cardiac disease.

Design and methods. A retrospective analysis of 100 pregnancy cases in patients with HCM (mean age 29,8 ± 6,0 years) from 2011 to 2025 was conducted. Patients were divided into groups based on left ventricular outflow tract (LVOT) obstruction and prior pregnancy history. Clinical and echocardiographic parameters, along with the frequency of pregnancy complications, were assessed. Statistical analysis was performed using the R programming language (Student’s t-test, Mann–Whitney U test, χ², linear regression).

Results. The clinical manifestations of the disease did not differ between the forms of HCM. An increase in left atrial diameter was observed in the third trimester compared to the second trimester, along with a trend toward a reduction in the peak LVOT obstruction gradient by the third trimester. Analysis of life-threatening arrhythmias (ventricular tachycardia) showed no significant differences between patients with different HCM forms. A higher frequency of ventricular arrhythmias was noted in patients with non-obstructive HCM during the first trimester.

Conclusions. Pregnancy in patients with HCM is associated with an increased incidence of ventricular arrhythmias and a higher estimated risk of sudden cardiac death (SCD) according to the European Society of Cardiology ESC HCM Risk-SCD risk score. The analysis revealed no significant differences in pregnancy course between patients with obstructive and non-obstructive forms of HCM.

1. Arbelo E, Protonotario A, Gimeno J, Arbustini E, BarrialesVilla R, Basso C, et al. 2023 ESC Guidelines for the management of cardiomyopathies: developed by the task force on the management of cardiomyopathies of the European Society of Cardiology (ESC). Eur Heart J. 2023;44(37):3503–3626. https://doi.org/10.1093/eurheartj/ehad194

2. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. ESC Scientific Document Group. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165–3241. https://doi.org/10.1093/eurheartj/ehy340

3. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Russian Journal of Cardiology. 2019;(6):151–228. (In Russ.) https://doi.org/10.15829/1560-4071-2019-6-151-228

4. Goland S, van Hagen IM, Elbaz-Greener G, Elkayam U, Shotan A, Merz WM, 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;38(35):2683–2690. https://doi.org/10.1093/eurheartj/ehx189

5. Abdeldayem J, Abdelfattah OM, Chaabo O, El Haddad D, Sharma G, Ahnert AM, et al. Long-Term impact of pregnancy on clinical outcomes in individuals with hypertrophic cardiomyopathy. JACC Adv. 2024;4(1):101426. https://doi.org/10.1016/j.jacadv.2024.101426

6. O’Mahony C, Jichi F., Pavlou M, Monserrat L, Anastasakis A, Rapezzi C, et al. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM RiskSCD). Eur Hear J 2014; 35(30): 2010–20. https://doi.org/10.1093/eurheartj/eht439.

7. Prossnitz ER, Barton M. Estrogen biology: new insights into GPER function and clinical opportunities. Mol Cell Endocrinol. 2014;389(1–2):71–83. https://doi.org/10.1016/j.mce.2014.02.002

8. Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation. 2014;130(12):1003–1008. https://doi.org/10.1161/CIRCULATIONAHA.114.009029

9. Stergiopoulos K, Shiang E, Bench T. Pregnancy in patients with pre-existing cardiomyopathies. J Am Coll Cardiol. 2011;58(4):337–350. https://doi.org/10.1016/j.jacc.2011.04.014

10. Zhao Z, Wang H, Jessup JA, Lindsey SH, Chappell MC, Groban L. Role of estrogen in diastolic dysfunction. Am J Physiol Heart Circ Physiol. 2014;306(5): H628–640. https://doi.org/10.1152/ajpheart.00859.2013

11. Ashikhmina E, Farber MK, Mizuguchi KA. Parturients with hypertrophic cardiomyopathy: case series and review of pregnancy outcomes and anesthetic management of labor and delivery. Int J Obstet Anesth. 2015;24(4):344–355. https://doi.org/10.1016/j.ijoa.2015.07.002

12. Schinkel AF. Pregnancy in women with hypertrophic cardiomyopathy. Cardiol Rev. 2014;22(5):217–222. https://doi.org/10.1097/CRD.0000000000000010

13. Autore C, Conte MR, Piccininno M, Bernabò P, Bonfiglio G, Bruzzi P, et al. Risk associated with pregnancy in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2002;40(10):1864–1869. https://doi.org/10.1016/s0735-1097(02)02495-6

14. Thaman R, Varnava A, Hamid MS, Firoozi S, Sachdev B, Condon M, et al, Pregnancy related complications in women with hypertrophic cardiomyopathy. Heart. 2003;89(7):752–756. https://doi.org/10.1136/heart.89.7.752

15. Turner GM, Oakley CM, Dixon HG. Management of pregnancy complicated by hypertrophic obstructive cardiomyopathy. Br Med J. 1968;4(5626):281–284. https://doi.org/10.1136/bmj.4.5626.281

16. Fumagalli C, Zocchi C, Cappelli F, Celata A, Tassetti L, Sasso L et al. Impact of pregnancy on the natural history of women with hypertrophic cardiomyopathy. Eur J Prev Cardiol. 2024;31(1):3–10. https://doi.org/10.1093/eurjpc/zwad257

17. Moolla M, Mathew A, John K, Yogasundaram H, Alhumaid W, Campbell S, Windram J. Outcomes of pregnancy in women with hypertrophic cardiomyopathy: a systematic review. Int J Cardiol. 2022;359:54–60. https://doi.org/10.1016/j.ijcard.2022.04.034