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Fumagalli C, Zocchi C, Cappelli F, Celata A, Tassetti L, Sasso L, Zampieri M, Argirò A, Marchi A, Targetti M, Berteotti M, Maurizi N, Mori F, Livi P, Baldini K, Tomberli A, Girolami F, Favilli S, Mecacci F, Olivotto I. Impact of pregnancy on the natural history of women with hypertrophic cardiomyopathy. Eur J Prev Cardiol 2024; 31:3-10. [PMID: 37531614 DOI: 10.1093/eurjpc/zwad257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
AIMS Whether pregnancy is a modifier of the long-term course and outcome of women with hypertrophic cardiomyopathy (HCM) is unknown. We assessed the association of pregnancy with long-term outcomes in HCM women. METHODS AND RESULTS Retrospective evaluation of women with HCM from 1970 to 2021. Only women with pregnancy-related information (pregnancy present or absent) and a follow-up period lasting ≥1 year were included. The peri-partum period was defined as -1 to 6 months after delivery. The primary endpoint was a composite for major adverse cardiovascular events [MACE: cardiovascular death, sudden cardiac death, appropriate defibrillator shock and heart failure (HF) progression]. Overall, 379 (58%) women were included. There were 432 pregnancies in 242 (63%) patients. In 29 (7.6%) cases, pregnancies (n = 39) occurred after HCM diagnosis. Among these, three carrying likely pathogenic sarcomeric variants suffered MACEs in the peri-partum period. At 10 ± 9 years of follow-up, age at diagnosis [hazard ratio (HR) 1.034, 95% confidence interval (CI) 1.018-1.050, P < 0.001] and New York Heart Association (NYHA) class (II vs. I: HR 1.944, 95% CI 0.896-4.218; III vs. I: HR 5.291, 95% CI 2.392-11.705, P < 0.001) were associated with MACE. Conversely, pregnancy was associated with reduced risk (HR 0.605; 95% CI 0.380-0.963, P = 0.034). Among women with pregnancy, multiple occurrences did not modify risk. CONCLUSIONS Pregnancy is not a modifier of long-term outcome in women with HCM and mostly occurs before a cardiac diagnosis. Most patients tolerate pregnancy well and do not show a survival disadvantage compared to women without. Pregnancy should not be discouraged, except in the presence of severe HF symptoms or high-risk features.
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Affiliation(s)
- Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Piazza Miraglia, 2, Naples 80138, Italy
| | - Chiara Zocchi
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Anastasia Celata
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Luigi Tassetti
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Laura Sasso
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Mattia Zampieri
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Alessia Argirò
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Alberto Marchi
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Martina Berteotti
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Niccolò Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Fabio Mori
- Obstetrics and Gynecology Unit, Careggi University Hospital, Florence, Italy
| | - Paola Livi
- Obstetrics and Gynecology Unit, Careggi University Hospital, Florence, Italy
| | - Katia Baldini
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Alessia Tomberli
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
| | - Francesca Girolami
- Pediatric Cardiology, Meyer Children's University Hospital, Florence, Italy
| | - Silvia Favilli
- Pediatric Cardiology, Meyer Children's University Hospital, Florence, Italy
| | - Federico Mecacci
- Obstetrics and Gynecology Unit, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Largo Brambilla, 3, Florence 50134, Italy
- Pediatric Cardiology, Meyer Children's University Hospital, Florence, Italy
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Cannata F, Pinto G, Chiarito M, Maurina M, Condello F, Bombace S, Villaschi A, Novelli L, Stankowski K, Liccardo G, Gasparini G, Donia D, Celata A, My I, Kallikourdis M, Figliozzi S, Mantovani R, Fazzari F, Bragato RM, Condorelli G, Stefanini GG. Long-term prognostic impact of subclinical myocardial dysfunction in patients recovered from COVID-19. Echocardiography 2023. [PMID: 37100745 DOI: 10.1111/echo.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Cardiovascular sequelae may occur in patients recovered from coronavirus disease 2019 (COVID-19). Recent studies have detected a considerable incidence of subclinical myocardial dysfunction-assessed with speckle-tracking echocardiography-and of long-COVID symptoms in these patients. This study aimed to define the long-term prognostic role of subclinical myocardial dysfunction and long-COVID condition in patients recovered from COVID-19 pneumonia. METHODS We prospectively followed up 110 patients hospitalized at our institution due to COVID-19 pneumonia in April 2020 and then recovered from SARS-CoV-2 infection. A 7-month clinical and echocardiographic evaluation was performed, followed by a 21-month clinical follow-up. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction, stroke, heart failure hospitalization, and all-cause mortality. RESULTS A subclinical myocardial dysfunction-defined as an impairment of left ventricular global longitudinal strain (≥-18%)-was identified at a 7-month follow-up in 37 patients (34%), was associated with an increased risk of long-term MACE with a good discriminative power (area under the curve: .73) and resulted in a strong independent predictor of extended MACE in multivariate regression analyses. Long-COVID condition was not associated with a worse long-term prognosis, instead. CONCLUSIONS In patients recovered from COVID-19 pneumonia, a subclinical myocardial dysfunction is present in one-third of the whole population at 7-month follow-up and is associated with a higher risk of MACE at long-term follow-up. Speckle-tracking echocardiography is a promising tool to optimize the risk-stratification in patients recovered from COVID-19 pneumonia, while the definition of a long-COVID condition has no prognostic relevance.
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Affiliation(s)
- Francesco Cannata
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Pinto
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mauro Chiarito
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Matteo Maurina
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesco Condello
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Sara Bombace
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Alessandro Villaschi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Laura Novelli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Kamil Stankowski
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gaetano Liccardo
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gaia Gasparini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Dario Donia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Anastasia Celata
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ilaria My
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Cardiology, Universitäres Herzzentrum, Hamburg, Germany
| | - Marinos Kallikourdis
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Fabio Fazzari
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Peri Operative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Gianluigi Condorelli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Cannata F, Pinto G, Chiarito M, Maurina M, Condello F, Bombace S, Villaschi A, Novelli L, Stankowski K, Liccardo G, Gasparini G, Donia D, Celata A, My I, Kallikourdis M, Figliozzi S, Mantovani R, Fazzari F, Bragato RM, Condorelli G, Stefanini GG. 144 LONG-TERM PROGNOSTIC IMPACT OF SUBCLINICAL MYOCARDIAL DYSFUNCTION IN PATIENTS RECOVERED FROM COVID-19. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Aims
Cardiovascular sequelae may occur in patients recovered from COVID-19. Recent studies have detected a considerable incidence of subclinical myocardial dysfunction – assessed with speckle-tracking echocardiography – and of long-COVID symptoms in these patients. This study aimed to define the long-term prognostic role of subclinical myocardial dysfunction and long-COVID condition in patients recovered from COVID-19 pneumonia.
Methods and Results
We prospectively followed-up 110 patients hospitalized at our Institution due to COVID-19 pneumonia in April 2020 and then recovered from SARS-CoV-2 infection. A 6-month clinical and echocardiographic evaluation was performed, followed by a 21-month clinical follow-up. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction, stroke, heart failure hospitalization and all-cause mortality. A subclinical myocardial dysfunction – defined as an impairment of left ventricular global longitudinal strain (≥ -18%) - was identified at 6-month follow-up in 37 patients (34%), was associated with an increased risk of long-term MACE with a good discriminative power (AUC: 0.73) and resulted a strong independent predictor of extended MACE in a multivariate regression analysis (OR 9.29, 95%CI 2.20–39.3, p=0.002). Long-COVID condition was not associated with a worse long-term prognosis, instead.
Conclusion
In patients recovered from COVID-19 pneumonia, a subclinical myocardial dysfunction is present in one third of the whole population at 6-month follow-up and is associated with a higher risk of MACE at long-term follow-up. Speckle-tracking echocardiography is a promising tool to optimise the risk-stratification in patients recovered from COVID-19 pneumonia, while the definition of a long-COVID condition has not prognostic relevance.
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Affiliation(s)
- Francesco Cannata
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Giuseppe Pinto
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Mauro Chiarito
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Matteo Maurina
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Francesco Condello
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Sara Bombace
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Alessandro Villaschi
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Laura Novelli
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Kamil Stankowski
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Gaetano Liccardo
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Gaia Gasparini
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Dario Donia
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Anastasia Celata
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Ilaria My
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
| | - Marinos Kallikourdis
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
| | | | | | - Fabio Fazzari
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | | | - Gianluigi Condorelli
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Giulio Giuseppe Stefanini
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
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Fumagalli C, Sasso L, Zocchi C, Tassetti L, Celata A, Berteotti M, Mori F, Mecacci F, Livi P, Cappelli F, Baldini K, Tomberli A, Favilli S, Olivotto I. Clinical course and outcome of pregnancy in patients with hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertrophic Cardiomyopathy (HCM) is the most common genetic cardiomyopathy. However, few studies have systematically investigated the clinical course of pregnancy in HCM.
Purpose
To determine whether pregnancy is well tolerated in HCM.
Methods
Women consecutively referred to our Tertiary Clinic for Cardiomyopathies from 1969 to
2019 were retrospectively reviewed. Only women with complete data regarding pregnancy and with a follow up (FU)>1 year were included in the study. Overall, of the 647 women followed at our center, 378 (58%) fulfilled our inclusion criteria. Demographic, clinical and instrumental records were retrieved. The peripartum period was defined as the timeframe from −1 to 6 months after delivery.
Results
There were 433 pregnancies in 239 (63%) women with 132 (62%) having >1 pregnancy. By contrast, 139 (37%) reported no pregnancy or miscarriages: in 6 cases pregnancy was discouraged due to advanced disease stage. Twenty-eight (12%) women had 39 pregnancies after HCM diagnosis and were followed by the obstetrics department: this subset was significantly younger at diagnosis (age at diagnosis: 21 [13–29] vs 56 [47–66] vs 45 [24–62] years, p<0.001, in women with a pregnancy after diagnosis vs women diagnosed after the pregnancy vs women with no pregnancy, respectively). Instrumental characteristics were comparable among women. Thirty percent presented with obstructive physiology at baseline. Among the 39 pregnancies in women who had a pregnancy after the diagnosis, there were 3 reported episodes of paroxysmal atrial fibrillation, one sustained ventricular tachycardia with pulse and three episodes of non-sustained ventricular tachycardia in the peripartum period. In this cohort, prevalence of intra-uterine growth delay and miscarriage was 8%. Only 3 women experienced a worsening clinical profile requiring hospitalization during the peripartum period: 2 were hospitalized for acute heart failure (AHF) and 1 was experienced a resuscitated cardiac arrest. Of note, 2/3 of patients were carriers of a (likely)pathogenic troponin mutation.
Long-term (FU: 5±3 years), nulligravida women were more symptomatic at last evaluation (NYHA III/IV: 25 vs 17, p<0.05), reported a higher incidence of ICD appropriate shocks (26 vs 12%p=0.02) but had similar rates of heart transplant (2.1 vs 0.5%, p=0.143) and episodes of AHF (12 vs 14%, p=0.193). Eighteen patients (8.2%) died: incidence of cardiovascular mortality was 4.8%, with a lower rate in patients who reported a pregnancy (0.8%/year vs 2.8%/year, p=0.01).
Conclusions
Women with HCM tolerate pregnancy well. Rare complications occurred in the peripartum period which were manageable. In the long-term, pregnancy, even when multiple, did not influence the long-term course of the disease nor its outcome. Strategies to support appropriate counselling and antenatal care should be implemented to identify those at greater risk of disease progression.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Fumagalli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - L Sasso
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - C Zocchi
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - L Tassetti
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - A Celata
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - M Berteotti
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - F Mori
- Careggi University Hospital, Florence, Italy
| | - F Mecacci
- Careggi University Hospital, Florence, Italy
| | - P Livi
- Careggi University Hospital, Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - K Baldini
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - A Tomberli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - S Favilli
- Meyer Children's Hospital, Cardiology Department, Florence, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
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