Sex-specific cardiac phenotype and clinical outcomes in patients with hypertrophic cardiomyopathy

Dai Yin Lu, Ioannis Ventoulis, Hongyun Liu, Shibani M. Kudchadkar, Gabriela V. Greenland, Hulya Yalcin, Effrosyni Kontari, Sagar Goyal, Celia P. Corona-Villalobos, Styliani Vakrou, Stefan L. Zimmerman, Theodore P. Abraham, M. Roselle Abraham

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)58-69
Number of pages12
JournalAmerican heart journal
Volume219
DOIs
StatePublished - Jan 2020

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Hypertrophic Cardiomyopathy
Phenotype
Muscular Diseases
Sex Characteristics
Heart Failure
Diastolic Heart Failure
Gadolinium
Ventricular Fibrillation
Ventricular Tachycardia
Stroke Volume
Atrial Fibrillation
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lu, D. Y., Ventoulis, I., Liu, H., Kudchadkar, S. M., Greenland, G. V., Yalcin, H., ... Abraham, M. R. (2020). Sex-specific cardiac phenotype and clinical outcomes in patients with hypertrophic cardiomyopathy. American heart journal, 219, 58-69. https://doi.org/10.1016/j.ahj.2019.10.004

Sex-specific cardiac phenotype and clinical outcomes in patients with hypertrophic cardiomyopathy. / Lu, Dai Yin; Ventoulis, Ioannis; Liu, Hongyun; Kudchadkar, Shibani M.; Greenland, Gabriela V.; Yalcin, Hulya; Kontari, Effrosyni; Goyal, Sagar; Corona-Villalobos, Celia P.; Vakrou, Styliani; Zimmerman, Stefan L.; Abraham, Theodore P.; Abraham, M. Roselle.

In: American heart journal, Vol. 219, 01.2020, p. 58-69.

Research output: Contribution to journalArticle

Lu, DY, Ventoulis, I, Liu, H, Kudchadkar, SM, Greenland, GV, Yalcin, H, Kontari, E, Goyal, S, Corona-Villalobos, CP, Vakrou, S, Zimmerman, SL, Abraham, TP & Abraham, MR 2020, 'Sex-specific cardiac phenotype and clinical outcomes in patients with hypertrophic cardiomyopathy', American heart journal, vol. 219, pp. 58-69. https://doi.org/10.1016/j.ahj.2019.10.004
Lu, Dai Yin ; Ventoulis, Ioannis ; Liu, Hongyun ; Kudchadkar, Shibani M. ; Greenland, Gabriela V. ; Yalcin, Hulya ; Kontari, Effrosyni ; Goyal, Sagar ; Corona-Villalobos, Celia P. ; Vakrou, Styliani ; Zimmerman, Stefan L. ; Abraham, Theodore P. ; Abraham, M. Roselle. / Sex-specific cardiac phenotype and clinical outcomes in patients with hypertrophic cardiomyopathy. In: American heart journal. 2020 ; Vol. 219. pp. 58-69.
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abstract = "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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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, M. Roselle

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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