Abstract 10351: Women With Hypertrophic Cardiomyopathy Have Worse Survival
Background: Gender differences in hypertrophic cardiomyopathy (HCM) demographics and survival remain unclear.
Methods: 3,673 adult patients with HCM underwent clinical evaluation at a single referral center between January 1975 and September 2012. Associations of clinical, echocardiographic and exercise variables with gender were tested with Fisher’s exact or Student t-test. Kaplan Meier survival curves were assessed via log-rank test.
Results: Mean follow-up was 4.9 ± 6.6 years with 1,661 patients (45%) female. At index visit, women were older (59±16 vs. 52±15 years, p<0.0001) and more likely to present with NYHA class III or IV symptoms (51.3 vs. 48.7%, p<0.0001). Transthoracic echocardiography revealed women have less septal thickening (17.8±5.5 vs. 18.3±5.5 mm, p=0.02), 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 right ventricular systolic pressure (n=1,783, 40.8±15.4 vs. 34.8±10.8 mmHg, p<0.0001). Women demonstrated worse cardiopulmonary exercise performance (n=1,267; maximum VO2 16.7±5.2 vs 22.2±6.7 mL/kg/min, p<0.0001; percent VO2 predicted 62.8±20 vs. 65.8±19.2%, p=0.007). Kaplan Meier analysis demonstrated lower survival in women when compared to men (Figure, log-rank p <0.0001), however when grouped by age quartiles, this relationship persisted only in the third quartile (age 57-67 years, log-rank p=0.01). Compared to age-matched white US controls, men had a 10-year survival of 70% (CI 67-73%, expected 78%, p<0.001), whereas females had a 10-year survival of 58% (CI 55-62%, expected 73%, p<0.001).
Conclusions: Women with HCM present at an older age with more symptoms and different hemodynamics compared to men. Women with HCM have worse survival, although this relationship is age-dependent.
- © 2013 by American Heart Association, Inc.