TY - JOUR
T1 - Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy
AU - Olivotto, Iacopo
AU - Maron, Martin S.
AU - Adabag, A. Selcuk
AU - Casey, Susan A.
AU - Vargiu, Daniela
AU - Link, Mark S.
AU - Udelson, James E.
AU - Cecchi, Franco
AU - Maron, Barry J.
N1 - Funding Information:
Supported in part by grants from the Fondazione Ente Cassa di Risparmio di Firenze and the Italian Ministry for Scientific and Technologic Research (PRIN 2004).
PY - 2005/8/2
Y1 - 2005/8/2
N2 - OBJECTIVES: The goal of this study was to assess gender-related differences in a multicenter population with hypertrophic cardiomyopathy (HCM). BACKGROUND: Little is known regarding the impact of gender on the heterogeneous clinical profile and clinical course of HCM. METHODS: We studied 969 consecutive HCM patients from Italy and the U.S. followed over 6.2 ± 6.1 years. RESULTS: Male patients had a 3:2 predominance (59%), similar in Italy and the U.S. (p = 0.24). At initial evaluation, female patients were older and more symptomatic than male patients (47 ± 23 years vs. 38 ± 18 years; p < 0.001; mean New York Heart Association [NYHA] functional class 1.8 ± 0.8 vs. 1.4 ± 0.6; p < 0.001), and more frequently showed left ventricular outflow obstruction (37% vs. 23%; p < 0.001). Moreover, female patients were less often diagnosed fortuitously by routine medical examination (23% vs. 41% in male patients, p < 0.001). Female gender was independently associated with the risk of symptom progression to NYHA functional classes III/IV or death from heart failure or stroke compared with male gender (independent relative hazard 1.5; p < 0.001), particularly patients ≥50 years of age and with resting outflow obstruction (p < 0.005). Hypertrophic cardiomyopathy-related mortality and risk of sudden death were similar in men and women. CONCLUSIONS: Women with HCM were under-represented, older, and more symptomatic than men, and showed higher risk of progression to advanced heart failure or death, often associated with outflow obstruction. These gender-specific differences suggest that social, endocrine, or genetic factors may affect the diagnosis and clinical course of HCM. A heightened suspicion for HCM in women may allow for timely implementation of treatment strategies, including relief of obstruction and prevention of sudden death or stroke.
AB - OBJECTIVES: The goal of this study was to assess gender-related differences in a multicenter population with hypertrophic cardiomyopathy (HCM). BACKGROUND: Little is known regarding the impact of gender on the heterogeneous clinical profile and clinical course of HCM. METHODS: We studied 969 consecutive HCM patients from Italy and the U.S. followed over 6.2 ± 6.1 years. RESULTS: Male patients had a 3:2 predominance (59%), similar in Italy and the U.S. (p = 0.24). At initial evaluation, female patients were older and more symptomatic than male patients (47 ± 23 years vs. 38 ± 18 years; p < 0.001; mean New York Heart Association [NYHA] functional class 1.8 ± 0.8 vs. 1.4 ± 0.6; p < 0.001), and more frequently showed left ventricular outflow obstruction (37% vs. 23%; p < 0.001). Moreover, female patients were less often diagnosed fortuitously by routine medical examination (23% vs. 41% in male patients, p < 0.001). Female gender was independently associated with the risk of symptom progression to NYHA functional classes III/IV or death from heart failure or stroke compared with male gender (independent relative hazard 1.5; p < 0.001), particularly patients ≥50 years of age and with resting outflow obstruction (p < 0.005). Hypertrophic cardiomyopathy-related mortality and risk of sudden death were similar in men and women. CONCLUSIONS: Women with HCM were under-represented, older, and more symptomatic than men, and showed higher risk of progression to advanced heart failure or death, often associated with outflow obstruction. These gender-specific differences suggest that social, endocrine, or genetic factors may affect the diagnosis and clinical course of HCM. A heightened suspicion for HCM in women may allow for timely implementation of treatment strategies, including relief of obstruction and prevention of sudden death or stroke.
UR - http://www.scopus.com/inward/record.url?scp=22844452302&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=22844452302&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2005.04.043
DO - 10.1016/j.jacc.2005.04.043
M3 - Article
C2 - 16053962
AN - SCOPUS:22844452302
SN - 0735-1097
VL - 46
SP - 480
EP - 487
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -