Abstract
BackgroundSex disparities are common in hypertrophic cardiomyopathy (HCM). Previous research has shown that at time of myectomy, women are older, have greater impairment of diastolic function and more advanced cardiac remodeling. The clinical impact of these differences is unknown. MethodThis study included 162 HCM patients (61% men) who underwent septal myectomy. Time to treatment was calculated in relation to symptom onset and diagnosis. Pre- and post-operative echocardiographic data were collected. Sex differences were assessed at baseline and in time-to-event survival analyses for the composite endpoint of all-cause mortality, cardiac transplantation, re-intervention and aborted sudden cardiac death. ResultsWomen were generally older at time of myectomy (57 vs. 49 years, p < 0.01), with similar time to treatment as measured from symptom onset (2.3 [1.3–6.0] vs. 2.8 [1.1–5.3] years, p > 0.05), but a shorter time since diagnosis compared to men (2.6 [1.2–7.0] vs. 4.3 [2.4–8.3] years, p = 0.02). Mean wall thickness and left atrial diameter were the same for men and women, but were higher in women when correcting for body surface area (absolute: 20 vs. 19 mm, 48 vs 46 mm, p ≥ 0.05; corrected: 9.7 vs. 11.2 mm/m2, 23.4 vs. 26.3 mm/m2, p < 0.01). After 5.9 [3.0–9.1] years, 15% of men and 8% of women had reached the composite endpoint (p > 0.05). ConclusionIn conclusion, although women present later in life and seem to have more advanced disease on echocardiography, time until myectomy was similar and clinical outcomes after myectomy are favourable for both men and women.
Highlights
Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited cardiac disease, with an estimated prevalence of 0.2–0.5% of the general population [1]
In hypertrophic cardiomyopathy (HCM) patients, the presence of left ventricular outflow tract (LVOT) obstruction is associated with significant morbidity and mortality [2,3]
The diagnosis of HCM was based on a maximal wall thickness (MWT) ≥15 mm (≥13 mm in first-degree relatives with HCM), not explained by loading conditions, in accordance with the guidelines [10]
Summary
Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited cardiac disease, with an estimated prevalence of 0.2–0.5% of the general population [1]. Advanced disease at time of myectomy, as reflected through a greater impairment of diastolic function and more fibrosis on microscopy [4] These findings are in unison with the older age of diagnosis and more symptomatic clinical presentation often observed in women with HCM, and are a possible indication of a delay in surgical treatment of women [5,6,7,8]. Previous research has shown that women with HCM start to exhibit symptoms later in life [9] Whether these age differences are truly secondary to diagnostic or therapeutic delays, rather than a reflection of an inherently different disease process, is unknown. Previous research has shown that at time of myectomy, women are older, have greater impairment of diastolic function and more advanced cardiac remodeling. Conclusion: In conclusion, women present later in life and seem to have more advanced disease on echocardiography, time until myectomy was similar and clinical outcomes after myectomy are favourable for both men and women
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