Results of a long-term follow-up of patients with hypertrophic cardiomyopathy after pregnancy

Abstract

Aim . To determine whether pregnancy is associated with a worsened clinical course and long-term prognosis in patients with hypertrophic cardiomyopathy (HCM), and to evaluate differences in maternal, obstetric, and cardiovascular outcomes between obstructive and non-obstructive disease forms. Material and methods. This single-center, ambispective cohort study was conducted at a perinatal center. The study included 102 patients with clinically confirmed HCM, who underwent 114 pregnancies between 2011 and 2025. Clinical status, electrocardiographic (ECG) and echocardiographic examinations were assessed in the first and third trimesters of pregnancy, in the early postpartum period, and during follow-up. The risk of sudden cardiac death (SCD) was calculated using the ESC HCM Risk-SCD score. The median follow-up was 5,8 years. R e sults . Obstructive and non-obstructive HCM was diagnosed in 33,3% and 66,7%, respectively. As pregnancy progressed, the incidence of clinical manifestations increased from 35% to 57%. During pregnancy, transient echocardiographic changes were observed, including an increased left atrial size (p=0,001 and p=0,002 for the obstructive and non-obstructive HCM, respectively). With the non-obstructive HCM, a more pronounced increase in interventricular septal thickness was noted (p<0,001). After delivery, most echocardiographic parameters returned to baseline values. In the second and third trimesters, a tendency towards an increase in the frequency of ventricular tachyarrhythmias was noted, followed by a decrease in the long-term period. SCD risk increased from the first trimester to the postpartum period and then decreased. With the obstructive HCM, premature births (36,8% vs 15,8%, p=0,036) and Cesarean delivery (71,1% vs 39,5%, p=0,012) were more often recorded. During the follow-up period, one sudden cardiac death (SCD) was recorded, and two patients underwent heart transplantation. Conclusion . Pregnancy in patients with HCM is associated with transient clinical and echocardiographic changes, most pronounced in the second and third trimesters, with regression after delivery. Despite a higher incidence of obstetric complications in the obstructive HCM, pregnancy  is  not  associated with  a  worse  long-term  prognosis  when  monitored  at  a  specialized  center.