Women with hypertrophic cardiomyopathy have worse survival

Jeffrey B. Geske, Kevin C. Ong, Konstantinos C. Siontis, Virginia B. Hebl, Michael John Ackerman, David O. Hodge, Virginia M Miller, Rick A. Nishimura, Jae Kuen Oh, Hartzell V Schaff, Bernard J. Gersh, Steve R. Ommen

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Aims Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. Methods and results Three thousand six hundred and seventy-three adult patients with HCM underwent evaluation between January 1975 and September 2012 with 1661 (45.2%) female. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of sex with survival. At index visit, women were older (59 ± 16 vs. 52 ± 15 years, P < 0.0001) had more symptoms [New York Heart Association (NYHA) Class III-IV 45.0% vs. 35.3%, P < 0.0001], 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/e0 ratio (n = 1649, 20.6 vs. 15.6, P < 0.0001), higher estimated pulmonary artery systolic pressure (n = 1783, 40.8 ± 15.4 vs. 34.8 ± 10.8 mmHg, P < 0.0001), worse cardiopulmonary exercise performance (n = 1267; percent VO2 predicted 62.8 ± 20% vs. 65.8 ± 19.2%, P = 0.007), and underwent more frequent alcohol septal ablation (4.9% vs. 3.0%, P = 0.004) but similar frequency of myectomy (28% vs. 30%, P = 0.24). Median follow-up was 10.9 (IQR 7.4-16.2) years. Kaplan-Meier analysis demonstrated lower survival in women compared with men (P < 0.0001). In multivariable modelling, female sex remained independently associated with mortality (HR 1.13 [1.03-1.22], P = 0.01) when adjusted for age, NYHA Class III-IV symptoms, and cardiovascular comorbidities. Conclusion Women with HCM present at more advanced age, with more symptoms, worse cardiopulmonary exercise tolerance, and different haemodynamics 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.

Original languageEnglish (US)
Pages (from-to)3434-3440
Number of pages7
JournalEuropean Heart Journal
Volume38
Issue number46
DOIs
StatePublished - Jan 1 2017

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Hypertrophic Cardiomyopathy
Survival
Kaplan-Meier Estimate
Sex Characteristics
Exercise Tolerance
Mitral Valve Insufficiency
Pulmonary Artery
Comorbidity
Referral and Consultation
Hemodynamics
Regression Analysis
Alcohols
Exercise
Blood Pressure
Mortality
Population

Keywords

  • Female
  • Gender
  • Hypertrophic cardiomyopathy
  • Male
  • Sex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Geske, J. B., Ong, K. C., Siontis, K. C., Hebl, V. B., Ackerman, M. J., Hodge, D. O., ... Ommen, S. R. (2017). Women with hypertrophic cardiomyopathy have worse survival. European Heart Journal, 38(46), 3434-3440. https://doi.org/10.1093/eurheartj/ehx527

Women with hypertrophic cardiomyopathy have worse survival. / Geske, Jeffrey B.; Ong, Kevin C.; Siontis, Konstantinos C.; Hebl, Virginia B.; Ackerman, Michael John; Hodge, David O.; Miller, Virginia M; Nishimura, Rick A.; Oh, Jae Kuen; Schaff, Hartzell V; Gersh, Bernard J.; Ommen, Steve R.

In: European Heart Journal, Vol. 38, No. 46, 01.01.2017, p. 3434-3440.

Research output: Contribution to journalArticle

Geske, JB, Ong, KC, Siontis, KC, Hebl, VB, Ackerman, MJ, Hodge, DO, Miller, VM, Nishimura, RA, Oh, JK, Schaff, HV, Gersh, BJ & Ommen, SR 2017, 'Women with hypertrophic cardiomyopathy have worse survival', European Heart Journal, vol. 38, no. 46, pp. 3434-3440. https://doi.org/10.1093/eurheartj/ehx527
Geske, Jeffrey B. ; Ong, Kevin C. ; Siontis, Konstantinos C. ; Hebl, Virginia B. ; Ackerman, Michael John ; Hodge, David O. ; Miller, Virginia M ; Nishimura, Rick A. ; Oh, Jae Kuen ; Schaff, Hartzell V ; Gersh, Bernard J. ; Ommen, Steve R. / Women with hypertrophic cardiomyopathy have worse survival. In: European Heart Journal. 2017 ; Vol. 38, No. 46. pp. 3434-3440.
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abstract = "Aims Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. Methods and results Three thousand six hundred and seventy-three adult patients with HCM underwent evaluation between January 1975 and September 2012 with 1661 (45.2{\%}) female. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of sex with survival. At index visit, women were older (59 ± 16 vs. 52 ± 15 years, P < 0.0001) had more symptoms [New York Heart Association (NYHA) Class III-IV 45.0{\%} vs. 35.3{\%}, P < 0.0001], 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/e0 ratio (n = 1649, 20.6 vs. 15.6, P < 0.0001), higher estimated pulmonary artery systolic pressure (n = 1783, 40.8 ± 15.4 vs. 34.8 ± 10.8 mmHg, P < 0.0001), worse cardiopulmonary exercise performance (n = 1267; percent VO2 predicted 62.8 ± 20{\%} vs. 65.8 ± 19.2{\%}, P = 0.007), and underwent more frequent alcohol septal ablation (4.9{\%} vs. 3.0{\%}, P = 0.004) but similar frequency of myectomy (28{\%} vs. 30{\%}, P = 0.24). Median follow-up was 10.9 (IQR 7.4-16.2) years. Kaplan-Meier analysis demonstrated lower survival in women compared with men (P < 0.0001). In multivariable modelling, female sex remained independently associated with mortality (HR 1.13 [1.03-1.22], P = 0.01) when adjusted for age, NYHA Class III-IV symptoms, and cardiovascular comorbidities. Conclusion Women with HCM present at more advanced age, with more symptoms, worse cardiopulmonary exercise tolerance, and different haemodynamics 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.",
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AU - Ong, Kevin C.

AU - Siontis, Konstantinos C.

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AU - Ackerman, Michael John

AU - Hodge, David O.

AU - Miller, Virginia M

AU - Nishimura, Rick A.

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AU - Gersh, Bernard J.

AU - Ommen, Steve R.

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N2 - Aims Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. Methods and results Three thousand six hundred and seventy-three adult patients with HCM underwent evaluation between January 1975 and September 2012 with 1661 (45.2%) female. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of sex with survival. At index visit, women were older (59 ± 16 vs. 52 ± 15 years, P < 0.0001) had more symptoms [New York Heart Association (NYHA) Class III-IV 45.0% vs. 35.3%, P < 0.0001], 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/e0 ratio (n = 1649, 20.6 vs. 15.6, P < 0.0001), higher estimated pulmonary artery systolic pressure (n = 1783, 40.8 ± 15.4 vs. 34.8 ± 10.8 mmHg, P < 0.0001), worse cardiopulmonary exercise performance (n = 1267; percent VO2 predicted 62.8 ± 20% vs. 65.8 ± 19.2%, P = 0.007), and underwent more frequent alcohol septal ablation (4.9% vs. 3.0%, P = 0.004) but similar frequency of myectomy (28% vs. 30%, P = 0.24). Median follow-up was 10.9 (IQR 7.4-16.2) years. Kaplan-Meier analysis demonstrated lower survival in women compared with men (P < 0.0001). In multivariable modelling, female sex remained independently associated with mortality (HR 1.13 [1.03-1.22], P = 0.01) when adjusted for age, NYHA Class III-IV symptoms, and cardiovascular comorbidities. Conclusion Women with HCM present at more advanced age, with more symptoms, worse cardiopulmonary exercise tolerance, and different haemodynamics 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.

AB - Aims Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. Methods and results Three thousand six hundred and seventy-three adult patients with HCM underwent evaluation between January 1975 and September 2012 with 1661 (45.2%) female. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of sex with survival. At index visit, women were older (59 ± 16 vs. 52 ± 15 years, P < 0.0001) had more symptoms [New York Heart Association (NYHA) Class III-IV 45.0% vs. 35.3%, P < 0.0001], 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/e0 ratio (n = 1649, 20.6 vs. 15.6, P < 0.0001), higher estimated pulmonary artery systolic pressure (n = 1783, 40.8 ± 15.4 vs. 34.8 ± 10.8 mmHg, P < 0.0001), worse cardiopulmonary exercise performance (n = 1267; percent VO2 predicted 62.8 ± 20% vs. 65.8 ± 19.2%, P = 0.007), and underwent more frequent alcohol septal ablation (4.9% vs. 3.0%, P = 0.004) but similar frequency of myectomy (28% vs. 30%, P = 0.24). Median follow-up was 10.9 (IQR 7.4-16.2) years. Kaplan-Meier analysis demonstrated lower survival in women compared with men (P < 0.0001). In multivariable modelling, female sex remained independently associated with mortality (HR 1.13 [1.03-1.22], P = 0.01) when adjusted for age, NYHA Class III-IV symptoms, and cardiovascular comorbidities. Conclusion Women with HCM present at more advanced age, with more symptoms, worse cardiopulmonary exercise tolerance, and different haemodynamics 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.

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