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Women with hypertrophic cardiomyopathy have worse survival

European heart journal, 2017-12, Vol.38 (46), p.3434-3440 [Peer Reviewed Journal]

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com. ;Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com. 2017 ;ISSN: 0195-668X ;EISSN: 1522-9645 ;DOI: 10.1093/eurheartj/ehx527 ;PMID: 29020402

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  • Title:
    Women with hypertrophic cardiomyopathy have worse survival
  • Author: Geske, Jeffrey B ; Ong, Kevin C ; Siontis, Konstantinos C ; Hebl, Virginia B ; Ackerman, Michael J ; Hodge, David O ; Miller, Virginia M ; Nishimura, Rick A ; Oh, Jae K ; Schaff, Hartzell V ; Gersh, Bernard J ; Ommen, Steve R
  • Subjects: Ablation Techniques - mortality ; Ablation Techniques - statistics & numerical data ; Cardiomyopathy, Hypertrophic - mortality ; Cardiomyopathy, Hypertrophic - therapy ; Clinical Research ; Echocardiography ; Editor's Choice ; Female ; Humans ; Kaplan-Meier Estimate ; Middle Aged ; Minnesota - epidemiology ; Proportional Hazards Models ; Sex Distribution
  • Is Part Of: European heart journal, 2017-12, Vol.38 (46), p.3434-3440
  • Description: Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. Three thousand six hundred and seventy-three adult patients with HCM underwent evaluation between January 1975 and September 2012 with 1661 (45.2%) female. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of sex with survival. At index visit, women were older (59 ± 16 vs. 52 ± 15 years, P < 0.0001) had more symptoms [New York Heart Association (NYHA) Class III-IV 45.0% vs. 35.3%, P < 0.0001], more obstructive physiology (77.4% vs. 71.8%, P = 0.0001), more mitral regurgitation (moderate or greater in 56.1% vs. 43.9%, P < 0.0001), higher E/e' ratio (n = 1649, 20.6 vs. 15.6, P < 0.0001), higher estimated pulmonary artery systolic pressure (n = 1783, 40.8 ± 15.4 vs. 34.8 ± 10.8 mmHg, P < 0.0001), worse cardiopulmonary exercise performance (n = 1267; percent VO2 predicted 62.8 ± 20% vs. 65.8 ± 19.2%, P = 0.007), and underwent more frequent alcohol septal ablation (4.9% vs. 3.0%, P = 0.004) but similar frequency of myectomy (28% vs. 30%, P = 0.24). Median follow-up was 10.9 (IQR 7.4-16.2) years. Kaplan-Meier analysis demonstrated lower survival in women compared with men (P < 0.0001). In multivariable modelling, female sex remained independently associated with mortality (HR 1.13 [1.03-1.22], P = 0.01) when adjusted for age, NYHA Class III-IV symptoms, and cardiovascular comorbidities. Women with HCM present at more advanced age, with more symptoms, worse cardiopulmonary exercise tolerance, and different haemodynamics than men. Sex is an important determinant in HCM management as women with HCM have worse survival. Women may require more aggressive diagnostic and therapeutic approaches.
  • Publisher: England: Oxford University Press
  • Language: English
  • Identifier: ISSN: 0195-668X
    EISSN: 1522-9645
    DOI: 10.1093/eurheartj/ehx527
    PMID: 29020402
  • Source: GFMER Free Medical Journals
    MEDLINE
    Alma/SFX Local Collection
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