1774 11 He moan'd heart-piercingly.
1881 M. C. Rowsell II. iii. 39 With a wail of pain those three last little words broke from her lips, so heart-piercingly, so utter in their desolate agony, that I started.
1996 (Nexis) 19 Apr. Emmy-lou's rendition was..heart-piercingly clear.