P2590Gender gap in hypertrophic cardiomyopathy: are female patients at increased risk?

Abstract

Introduction: Key differences among men and women have been explored in multiple cardiac conditions. However, gender differences in hypertrophic cardiomyopathy (HCM) are less clear. Recently, a worse prognosis in females with HCM in an American-based population was identified. Aims: We aim to characterize gender differences in overall and cardiovascular (CV) mortality in a large, European country-based nationwide HCM registry. Methods and results: 1042 adult patients with HCM that underwent evaluation between 1975 and 2015 were enrolled in a national registry, with 429 (41.2%) females and mean age at diagnosis of 53.3 years. Mean follow-up was 65±75 months. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of gender with time of death. At index visit, women were older (56±16 vs. 51±15 years, P<0.001) had more symptoms (56.4%, vs. 51.7%, P<0.001), more mitral regurgitation (moderate or greater in 33.4% vs. 21.7%, P=0.003), more diastolic dysfunction (75.2% vs. 64.1% P=0.001), performed less stress ECG (36.5% vs. 46.6% p=0.001) and stress echocardiography (13.7% vs. 19.4% p=0.018). Men had more previously known coronary artery disease (7.1% vs. 2.7%, p=0.003). Women had higher B-type natriuretic peptide at diagnosis (920±5420 mg/dL vs. 487±2014 mg/dL, p<0.001). Women underwent less defibrillator implantation (10.9% vs. 15.6%, p=0.032), more alcohol septal ablation (3.5% vs. 1.3% p=0.018) but had similar frequency of myectomy (6.0% vs. 6.0%, p=0.987). Kaplan-Meier analysis showed higher overall (8.4% vs. 5.0%, p=0.026) and cardiovascular (5.5% vs. 2.2%, p=0.004) mortality in women compared with men (picture 1). In multivariable modeling, female gender remained independently associated with overall mortality (HR 2.05 [1.11-3.78], P=0.021) and CV mortality (HR 3.16 [1.25-7.99], P=0.015) after adjustment for all previous statistically significant differences. Conclusion: Based on the current data european women with HCM have a lower survival rate when compared with men. Female gender is an independent risk factor for global and cardiovascular death even after adjustment for multiple variables.