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A new gender gap: are female patients with hypertrophic cardiomyopathy at increased risk of death?
Session:
Posters 2 - Écran 09 - Miocárdio e Pericárdio
Speaker:
Fernando Montenegro Sá
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Fernando Montenegro Sá; Catarina Ruivo; Joana Correia; Em nome dos investigadores do Registo Nacional de Miocardiopatia Hipertrófica
Abstract
<p><strong>Introduction</strong>: 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.</p> <p><strong>Aims: </strong>We aim to characterize gender differences in overall and cardiovascular (CV) mortality in a large, European country-based nationwide HCM registry.</p> <p><strong>Methods and results: </strong>1042 Portuguese 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, <em><u>P</u></em> < 0.001) had more symptoms (56.4%, vs. 51.7%, <em>P</em> < 0.001), more mitral regurgitation (moderate or greater in 33.4% vs. 21.7%, <em>P</em> = 0.003), more diastolic dysfunction (75.2% vs. 64.1% <em>P</em> = 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], <em>P</em> = 0.021) and CV mortality (HR 3.16 [1.25–7.99], <em>P</em> = 0.015) after adjustment for all previous statistically significant differences.</p> <p><strong>Conclusion: </strong>Based on the current data women with HCM have a lower survival rate when compared with men. Gender female is an independent risk factor for death even after adjustment for multiple variables. These results are in agreement with the previously published American based observations.</p>
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