Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy.
OBJECTIVE
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 > or =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.
Olivotto
Iacopo
I
Regional Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. olivottoi@ao-careggi.toscana.it
Maron
Martin S
MS
Adabag
A Selcuk
AS
Casey
Susan A
SA
Vargiu
Daniela
D
Link
Mark S
MS
Udelson
James E
JE
Cecchi
Franco
F
Maron
Barry J
BJ
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*; D002423:Cause of Death; D015331:Cohort Studies; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011336:Probability; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*