TY - JOUR
T1 - Sex-specific cardiac phenotype and clinical outcomes in patients with hypertrophic cardiomyopathy
AU - Lu, Dai Yin
AU - Ventoulis, Ioannis
AU - Liu, Hongyun
AU - Kudchadkar, Shibani M.
AU - Greenland, Gabriela V.
AU - Yalcin, Hulya
AU - Kontari, Effrosyni
AU - Goyal, Sagar
AU - Corona-Villalobos, Celia P.
AU - Vakrou, Styliani
AU - Zimmerman, Stefan L.
AU - Abraham, Theodore P.
AU - Abraham, Roselle
N1 - Funding Information:
This work was supported by the JTB (John Taylor Babbitt) Foundation and startup funds from the UCSF Division of Cardiology to MRA. Dr. Lu was supported by Taipei Veterans General Hospital-National Yang-Ming University Excellent Physician Scientists Cultivation Program, No. 104-V-A-005. Dr. Ventoulis and Dr. Vakrou were supported by grants from the Hellenic Society of Cardiology. Dr. Yalçin was supported by a Fulbright Fellowship (Bureau of Educational and Cultural Affairs, United States Department of State). We thank Glenn Lie and Gunnar Hansen (GE Ultrasound, Horten, Norway) for providing the strain analysis software, Susan Phillip and the Johns Hopkins Echocardiography laboratory for their support. We thank Dr. Daniel Judge, Emily Brown and Rebecca McClellan for their help with clinical genotyping of HCM patients. Appendix A
Funding Information:
This work was supported by the JTB (John Taylor Babbitt) Foundation and startup funds from the UCSF Division of Cardiology to MRA. Dr. Lu was supported by Taipei Veterans General Hospital-National Yang-Ming University Excellent Physician Scientists Cultivation Program, No. 104-V-A-005. Dr. Ventoulis and Dr. Vakrou were supported by grants from the Hellenic Society of Cardiology. Dr. Yal?in was supported by a Fulbright Fellowship (Bureau of Educational and Cultural Affairs, United States Department of State). We thank Glenn Lie and Gunnar Hansen (GE Ultrasound, Horten, Norway) for providing the strain analysis software, Susan Phillip and the Johns Hopkins Echocardiography laboratory for their support. We thank Dr. Daniel Judge, Emily Brown and Rebecca McClellan for their help with clinical genotyping of HCM patients.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/1
Y1 - 2020/1
N2 - Background: It is unknown whether sex-specific differences in mortality observed in HCM are due to older age of women at presentation, or whether women have greater degree of LV myopathy than men. Methods: We retrospectively compared clinical/imaging characteristics and outcomes between women and men in our overall cohort composed of 728 HCM patients, and in an age-matched subgroup comprised of 400 age-matched patients. We examined sex-specific differences in LV myopathy, and dissected the influence of age and sex on outcomes. LV myopathy was assessed by measuring LV mass, LVEF, global peak longitudinal systolic strain (LV-GLS), diastolic function (E/A, E/e′), late gadolinium enhancement (LV-LGE) and myocardial blood flow (MBF) at rest/stress. The primary endpoint was a composite outcome, comprising heart failure (HF), atrial fibrillation (AFib), ventricular tachycardia/fibrillation (VT/VF) and death; individual outcomes were defined as the secondary endpoint. Results: Women in the overall cohort were older by 6 years. Women were more symptomatic and more likely to have obstructive HCM. Women had smaller LV cavity size, stroke volume and LV mass, higher indexed maximum wall thickness (IMWT), more hyperdynamic LVEF and higher/similar LV-GLS. Women had similar LV-LGE and E/A, but higher E/e′ and rest/stress MBF. Female sex was independently associated with the composite outcome in the overall cohort, and with HF in the overall cohort and age-matched subgroup after adjusting for obstructive HCM, LA diameter, LV-GLS. Conclusions: Our results suggest that sex-specific differences in LV geometry, hyper-contractility and diastolic function, not greater degree of LV myopathy, contribute to a higher, age-independent risk of diastolic HF in women with HCM.
AB - Background: It is unknown whether sex-specific differences in mortality observed in HCM are due to older age of women at presentation, or whether women have greater degree of LV myopathy than men. Methods: We retrospectively compared clinical/imaging characteristics and outcomes between women and men in our overall cohort composed of 728 HCM patients, and in an age-matched subgroup comprised of 400 age-matched patients. We examined sex-specific differences in LV myopathy, and dissected the influence of age and sex on outcomes. LV myopathy was assessed by measuring LV mass, LVEF, global peak longitudinal systolic strain (LV-GLS), diastolic function (E/A, E/e′), late gadolinium enhancement (LV-LGE) and myocardial blood flow (MBF) at rest/stress. The primary endpoint was a composite outcome, comprising heart failure (HF), atrial fibrillation (AFib), ventricular tachycardia/fibrillation (VT/VF) and death; individual outcomes were defined as the secondary endpoint. Results: Women in the overall cohort were older by 6 years. Women were more symptomatic and more likely to have obstructive HCM. Women had smaller LV cavity size, stroke volume and LV mass, higher indexed maximum wall thickness (IMWT), more hyperdynamic LVEF and higher/similar LV-GLS. Women had similar LV-LGE and E/A, but higher E/e′ and rest/stress MBF. Female sex was independently associated with the composite outcome in the overall cohort, and with HF in the overall cohort and age-matched subgroup after adjusting for obstructive HCM, LA diameter, LV-GLS. Conclusions: Our results suggest that sex-specific differences in LV geometry, hyper-contractility and diastolic function, not greater degree of LV myopathy, contribute to a higher, age-independent risk of diastolic HF in women with HCM.
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U2 - 10.1016/j.ahj.2019.10.004
DO - 10.1016/j.ahj.2019.10.004
M3 - Article
C2 - 31726421
AN - SCOPUS:85074683742
SN - 0002-8703
VL - 219
SP - 58
EP - 69
JO - American Heart Journal
JF - American Heart Journal
ER -