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      Women with hypertrophic cardiomyopathy have worse survival

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          Abstract

          <div class="section"> <a class="named-anchor" id="s1"> <!-- named anchor --> </a> <h5 class="section-title" id="d4415131e260">Aims</h5> <p id="d4415131e262">Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. </p> </div><div class="section"> <a class="named-anchor" id="s2"> <!-- named anchor --> </a> <h5 class="section-title" id="d4415131e265">Methods and results</h5> <p id="d4415131e267">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, <i> <span style="text-decoration: underline">P</span> </i> &lt; 0.0001) had more symptoms [New York Heart Association (NYHA) Class III–IV 45.0% vs. 35.3%, <i>P</i> &lt; 0.0001], more obstructive physiology (77.4% vs. 71.8%, <i>P</i> = 0.0001), more mitral regurgitation (moderate or greater in 56.1% vs. 43.9%, <i>P</i> &lt; 0.0001), higher <i>E</i>/ <i>e</i>′ ratio ( <i>n</i> = 1649, 20.6 vs. 15.6, <i>P</i> &lt; 0.0001), higher estimated pulmonary artery systolic pressure ( <i>n</i> = 1783, 40.8 ± 15.4 vs. 34.8 ± 10.8 mmHg, <i>P</i> &lt; 0.0001), worse cardiopulmonary exercise performance ( <i>n</i> = 1267; percent VO <sub>2</sub> predicted 62.8 ± 20% vs. 65.8 ± 19.2%, <i>P</i> = 0.007), and underwent more frequent alcohol septal ablation (4.9% vs. 3.0%, <i>P</i> = 0.004) but similar frequency of myectomy (28% vs. 30%, <i>P</i> = 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 ( <i>P</i> &lt; 0.0001). In multivariable modelling, female sex remained independently associated with mortality (HR 1.13 [1.03–1.22], <i>P</i> = 0.01) when adjusted for age, NYHA Class III–IV symptoms, and cardiovascular comorbidities. </p> </div><div class="section"> <a class="named-anchor" id="s3"> <!-- named anchor --> </a> <h5 class="section-title" id="d4415131e326">Conclusion</h5> <p id="d4415131e328">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. </p> <p id="d4415131e330"> <div class="fig panel" id="ehx527-F2a"> <a class="named-anchor" id="ehx527-F2a"> <!-- named anchor --> </a> <div class="figure-container so-text-align-c"> <img alt="" class="figure" src="/document_file/403ddd7e-d81b-409d-9207-10384c431877/PubMedCentral/image/ehx527f2a"/> </div> <div class="panel-content"/> </div> </p> </div>

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          Author and article information

          Journal
          European Heart Journal
          Oxford University Press (OUP)
          0195-668X
          1522-9645
          December 07 2017
          December 07 2017
          September 08 2017
          December 07 2017
          December 07 2017
          September 08 2017
          : 38
          : 46
          : 3434-3440
          Article
          10.1093/eurheartj/ehx527
          6251550
          29020402
          5503fa5b-72ea-4c5e-80ba-0e605845cd68
          © 2017
          History

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