Worse Survival for Women With Hypertrophic Cardiomyopathy

Study Questions:

Do women and men with hypertrophic cardiomyopathy (HCM) have similar outcomes?

Methods:

Patients evaluated at Mayo Clinic between 1975 and 2012 who were diagnosed with HCM were included in this cohort. For the present study, only those with an index evaluation at Mayo were included. Echocardiography, electrocardiograms, and blood work were collected on participants. The primary outcome of interest was long-term mortality. Follow-up occurred through January of 2017.

Results:

A total of 3,673 adults with HCM were included in the present study, of which 45.2% were female. At the index visit, women were older (59 ± 16 vs. 52 ± 15 years, p < 0.0001) and had more symptoms (New York Heart Association [NYHA] class III–IV 45.0% vs. 35.3%, p < 0.0001) compared with men. On echocardiography, women had 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 = 1,649, 20.6 vs. 15.6, p < 0.0001), and higher estimated pulmonary artery systolic pressure (n = 1,783, 40.8 ± 15.4 vs. 34.8 ± 10.8 mm Hg, p < 0.0001) than men. Women also had worse cardiopulmonary exercise performance (n = 1,267; percent VO2 predicted 62.8 ± 20% vs. 65.8 ± 9.2%, p = 0.007) compared with men. Women were more likely to undergo alcohol septal ablation (4.9% vs. 3.0%, p = 0.004); however, rates for myectomy were similar for men and women (28% vs. 30%, p = 0.24). Over a median follow-up of 10.9 (interquartile range, 7.4–16.2) years, women have a lower survival rate compared with men. In multivariable modeling, female sex remained independently associated with mortality (hazard ratio 1.13 [1.03–1.22], p = 0.01) when adjusted for age, NYHA class III–IV symptoms, and cardiovascular comorbidities.

Conclusions:

The authors concluded that women with HCM present at a more advanced age, with more symptoms, worse cardiopulmonary exercise tolerance, and different hemodynamics 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.

Perspective:

These data suggest that women with HCM have more symptoms and worse exercise tolerance, possibly related to hemodynamic differences, compared with men. Given the worse survival among women with HCM, improving current understanding of the treatment of women with HCM is warranted.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Valvular Heart Disease, Acute Heart Failure, Echocardiography/Ultrasound, Mitral Regurgitation

Keywords: Blood Pressure, Cardiomyopathy, Hypertrophic, Comorbidity, Echocardiography, Electrocardiography, Exercise Tolerance, Female, Heart Failure, Mitral Valve Insufficiency, Outcome Assessment (Health Care), Primary Prevention, Pulmonary Wedge Pressure, Survival Rate, Women


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