925-45 Is There a Gender Gap in Clinical Presentation and Outcome of Hypertrophic Cardiomyopathy?

Abstract

A bias in referral as well as a worse outcome have been recently observed in female patients with various cardiac disorders. It remains unexplored, however, whether these gender related differences occur also in hypertrophic cardiomyopathy (HC). To address this issue, we compared the presenting features and outcomes in 84 men (M) and 65 women (W) with HC, who were consecutively referred to us for hemodynamic evaluation. Time from onset of symptoms to referral was longer in W than in M (23 ± 11 vs 12 ± 8 months, p < 0.001). Also, W were older (44 ± 12 vs 35 ± 10 years, p < 0.001), and had a higher prevalence of chest pain (46% vs 23%, p < 0.01), dyspnea (58% vs 30%, p < 0.001), and syncope or presyncope (42% vs 21%, p < 0.02), as compared with M. Doppler echocardiography showed that the two groups had similar LV dimension, mass, as well as syte and extent of hypertrophy, whereas W had a lower ratio of transmitral early to late peak filling waves than M (0.8 ± 0.3 vs 1.2 ± 0.4, p < 0.001), thus indicating a worse LV diastolic function. In addition, at stress testing, W exhibited a shorter duration of exercise than M (4.5 ± 1.2 vs 7.4 ± 1.5 min, p < 0.001). At catheterization, there were no gender associated differences in prevalence of LV obstruction, ejection fraction, cardiac index, as well as right- and left-sided intracavitary pressures. During a follow-up of 8 ± 4 years, sudden death occurred in 11 M (13%) and 17 W (26%), whereas 3 M (5%) and 4 W (6%) died from heart failure or were transplanted. Total unadjusted cardiac mortality was significantly (p = 0.02) higher in W than in M, with a relative odds ratio of 1.94. However, after multivariate correction for age, symptoms, LV filling, and exercise capacity, the gender difference in mortality was no longer found (odds ratio 1.15). It is concluded that: (1)the gender bias in referral, as described in other conditions, occurs also in HC, W being referred when are older, more symptomatic, and in a worse functional status than M; (2) female gender, however, does not appear to influence “per se” the morphologic expression or the clinical course of the disease.