Worse Survival for Women With Hypertrophic Cardiomyopathy

Results:

A total of 3,673 adults with HCM were included in the present study, of which 45.2% were female. At the index visit, women were older (59 ± 16 vs. 52 ± 15 years, p < 0.0001) and had more symptoms (New York Heart Association [NYHA] class III–IV 45.0% vs. 35.3%, p < 0.0001) compared with men. On echocardiography, women had 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 = 1,649, 20.6 vs. 15.6, p < 0.0001), and higher estimated pulmonary artery systolic pressure (n = 1,783, 40.8 ± 15.4 vs. 34.8 ± 10.8 mm Hg, p < 0.0001) than men. Women also had worse cardiopulmonary exercise performance (n = 1,267; percent VO₂ predicted 62.8 ± 20% vs. 65.8 ± 9.2%, p = 0.007) compared with men. Women were more likely to undergo alcohol septal ablation (4.9% vs. 3.0%, p = 0.004); however, rates for myectomy were similar for men and women (28% vs. 30%, p = 0.24). Over a median follow-up of 10.9 (interquartile range, 7.4–16.2) years, women have a lower survival rate compared with men. In multivariable modeling, female sex remained independently associated with mortality (hazard ratio 1.13 [1.03–1.22], p = 0.01) when adjusted for age, NYHA class III–IV symptoms, and cardiovascular comorbidities.