Women with hypertrophic cardiomyopathy (HCM) may require more aggressive diagnostic and therapeutic approaches as they have worse survival than men with HCM, according to a study published Sept. 8 in the European Heart Journal.

Jeffrey B. Geske, MD, FACC, et al., assessed sex differences in individuals with HCM by evaluating 3,673 HCM patients – 1,661 of them women – between January 1975 and September 2012. Patient survival was assessed using Kaplan-Meier survival curves and Cox proportional hazard regression analyses were performed to determine the relationship between sex and survival.

Results showed that at the index visit, women compared with men were older (59 vs. 52 years) and had more symptoms (New York Heart Association (NYHA) Class III–IV heart failure, 45.0 percent vs. 35.3 percent). Women also had more obstructive physiology (77.4 percent vs. 71.8 percent) and mitral regurgitation (moderate or greater in 56.1 percent vs. 43.9 percent), and a higher E/e′ ratio (20.6 percent vs. 15.6 percent) and higher estimated pulmonary artery systolic pressure (40.8 mm Hg vs. 34.8 mm Hg).

Cardiopulmonary exercise performance as measured as percent VO2 predicted was worse in more women than men (62.8 percent vs. 65.8 percent). While alcohol septal ablation was more frequent in women than in men (4.9 percent vs. 3.0 percent), the frequency of myectomy was similar (28 percent vs. 30 percent).

At median follow-up of 10.9 years, 1, 477 deaths occurred and median survival in patients who died was 9 years after index evaluation. The Kaplan-Meier analysis showed lower survival in women than men. Five-year survival estimates demonstrated a difference between expected and observed survival of 5.4 percent in women (90.5 percent vs. 85.1 percent), as compared with 0.9 percent in men (92.0 percent vs. 91.1 percent). Ten-year survival estimates revealed a difference of 8.1 percent in women (78.9 percent vs. 70.8 percent), as compared with 0.7 percent in men (82.7 percent vs. 82.0 percent).

In multivariable modelling, female sex remained independently associated with mortality (hazard ratio, 1.13) when adjusted for age, NYHA Class III–IV symptoms and cardiovascular comorbidities.

“These numerous significant clinical differences underscore a need for recognition of the sex and gender differences in the diagnosis and care of patients with HCM,” the study authors write. “Women with HCM may benefit from more intensive surveillance and medical therapies, as well as earlier consideration of septal reduction therapies.”

Keywords: Kaplan-Meier Estimate, Survival Rate, Mitral Valve Insufficiency, Comorbidity, Sex Characteristics, Follow-Up Studies, Blood Pressure, Pulmonary Artery, Cardiomyopathy, Hypertrophic, Proportional Hazards Models, Cardiac Surgical Procedures, Heart Failure

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