Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 7;38(46):3434-3440.
doi: 10.1093/eurheartj/ehx527.

Women with hypertrophic cardiomyopathy have worse survival

Jeffrey B Geske  1 , Kevin C Ong  1 , Konstantinos C Siontis  2 , Virginia B Hebl  1 , Michael J Ackerman  1   3   4 , David O Hodge  5 , Virginia M Miller  6 , Rick A Nishimura  1 , Jae K Oh  1 , Hartzell V Schaff  7 , Bernard J Gersh  1 , Steve R Ommen  1
Affiliations

Women with hypertrophic cardiomyopathy have worse survival

Jeffrey B Geske et al. Eur Heart J. .

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/e' 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.

Keywords: Female; Gender; Hypertrophic cardiomyopathy; Male; Sex.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Survival in all patients stratified by sex. Kaplan–Meier survival curves grouped by sex demonstrate worse survival in women (red) as opposed to men (blue).
Take home figure 2
Take home figure 2
Survival comparison of patients with hypertrophic cardiomyopathy to an age- and sex-matched US population. Kaplan–Meier assessment of men with hypertrophic cardiomyopathy (solid blue line) compared with an age- and sex-matched US population (dashed blue line). Women with hypertrophic cardiomyopathy (solid red line) compared with an age- and sex-matched US population (dashed red line). HCM, hypertrophic cardiomyopathy.
None
See this image and copyright information in PMC

Comment in

References

    1. Maron BJ, Epstein SE.. Hypertrophic cardiomyopathy: a discussion of nomenclature. Am J Cardiol 1979;43:1242–1244. - PubMed
    1. Sorajja P, Nishimura RA, Ommen SR, Ackerman MJ, Tajik AJ, Gersh BJ.. Use of echocardiography in patients with hypertrophic cardiomyopathy: clinical implications of massive hypertrophy. J Am Soc Echocardiogr 2006;19:788–795. - PubMed
    1. Authors/Task Force members, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H.. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014;35:2733–2779. - PubMed
    1. Williams M, Kodali SK, Hahn RT, Humphries KH, Nkomo V, Cohen DJ, Douglas PS, Mack M, McAndrew TC, Svensson L, Thourani VH, Tuzcu EM, Weissman NJ, Kirtane AJ, Leon MB.. Sex-related differences in outcomes following transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis: insights from the PARTNER trial. J Am Coll Cardiol 2014;63:1522–1528. - PubMed
    1. Zhao ZG, Liao YB, Peng Y, Chai H, Liu W, Li Q, Ren X, Wang XQ, Luo XL, Zhang C, Lu LH, Meng QT, Chen C, Chen M, Feng Y, Huang DJ.. Sex-related differences in outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis. Circ Cardiovasc Interv 2013;6:543–551. - PubMed