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J Am Coll Cardiol. 2005 Aug 2;46(3):480-7.

Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy.

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  • 1Regional Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. olivottoi@ao-careggi.toscana.it

Abstract

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 > 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.

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