摘要
OBJECTIVES: The goal of this study was to assess gender-related differences in a multicenter population with hypertrophic cardiomyopathy(HCM). BACKGROUND: Little is known regarding the impact of gender on the heterogeneous clinical profile and clinical course of HCM. METHODS: We studied 969 consecutive HCM patients from Italy and the U.S. followed over 6.2±6.1 years. RESULTS: Male patients had a 3:2 predominance(59%), similar in Italy and the U.S.(p=0.24). At initial evaluation, female patients were older and more symptomatic than male patients(47±23 years vs. 38±18 years; p< 0.001; mean New York Heart Association[NYHA] functional class 1.8±0.8 vs. 1.4±0.6; p< 0.001), and more frequently showed left ventricular outflow obstruction(37%vs. 23%; p< 0.001). Moreover, female patients were less often diagnosed fortuitously by routine medical examination(23%vs. 41%in male patients, p< 0.001). Female gender was independently associated with the risk of symptom progression to NYHA functional classes III/IV or death from heart failure or stroke compared with male gender(independent relative hazard 1.5; p< 0.001), particularly patients≥50 years of age and with resting outflow obstruction(p< 0.005). Hypertrophic cardiomyopathy-related mortality and risk of sudden death were similar in men and women. CONCLUSIONS: Women with HCM were under-represented, older, and more symptomatic than men, and showed higher risk of progression to advanced heart failure or death, often associated with outflow obstruction. These gender-specific differences suggest that social, endocrine, or genetic factors may affect the diagnosis and clinical course of HCM. A heightened suspicion for HCM in women may allow for timely implementation of treatment strategies, including relief of obstruction and prevention of sudden death or stroke.
OBJECTIVES: The goal of this study was to assess gender-related differences in a multicenter population with hypertrophic cardiomyopathy(HCM). BACKGROUND: Little is known regarding the impact of gender on the heterogeneous clinical profile and clinical course of HCM. METHODS: We studied 969 consecutive HCM patients from Italy and the U.S. followed over 6.2±6.1 years. RESULTS: Male patients had a 3:2 predominance(59%), similar in Italy and the U.S.(p=0.24). At initial evaluation, female patients were older and more symptomatic than male patients(47±23 years vs. 38±18 years; p< 0.001; mean New York Heart Association[NYHA] functional class 1.8±0.8 vs. 1.4±0.6; p< 0.001), and more frequently showed left ventricular outflow obstruction(37%vs. 23%; p< 0.001). Moreover, female patients were less often diagnosed fortuitously by routine medical examination(23%vs. 41%in male patients, p< 0.001). Female gender was independently associated with the risk of symptom progression to NYHA functional classes III/IV or death from heart failure or stroke compared with male gender(independent relative hazard 1.5; p< 0.001), particularly patients≥50 years of age and with resting outflow obstruction(p< 0.005). Hypertrophic cardiomyopathy-related mortality and risk of sudden death were similar in men and women. CONCLUSIONS: Women with HCM were under-represented, older, and more symptomatic than men, and showed higher risk of progression to advanced heart failure or death, often associated with outflow obstruction. These gender-specific differences suggest that social, endocrine, or genetic factors may affect the diagnosis and clinical course of HCM. A heightened suspicion for HCM in women may allow for timely implementation of treatment strategies, including relief of obstruction and prevention of sudden death or stroke.
