Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiology. 2020;145(4):203-214. doi: 10.1159/000505680. Epub 2020 Feb 18.
The clinical condition of hypertrophic obstructive cardiomyopathy (HOCM) and concomitant systemic hypertension is growing more and more prevalent, and it brings about a challenging diagnostic and therapeutic dilemma. However, whether systemic hypertension has an impact on HOCM, and whether sex-related differences exist in this impact, remains unclear.
A total of 453 HOCM patients (age 48.7 ± 12.8 years, 252 [55.6%] males) were recruited in this study. There were 150 patients (33.1%, 81 males and 69 females) with a history of controlled systemic hypertension. Cardiac magnetic resonance (CMR) imaging was performed in all patients. Left ventricular (LV) remodeling index (LVRI) was determined by CMR. LVRI >1.3 g/mL was defined as pathological LV remodeling.
Men had significantly greater LVRI (1.40 ± 0.54 vs. 1.15 ± 0.38 g/mL, p < 0.001) and LVRI >1.3 g/mL (p = 0.002), compared with women. The incidence of syncope and 5-year sudden cardiac death risk score were significantly lower in HOCM with hypertension than those without hypertension. LVRI (p = 0.003) and LVRI >1.3 g/mL (p = 0.007) were significantly smaller in males with hypertension, but not in females with hypertension. However, log cardiac troponin I and log N-terminal pro-B-type natriuretic peptide were positively correlated with LVRI in men and women. On multivariable logistic analysis, hypertension (OR 0.172, 95% CI 0.056-0.528, p = 0.002) remained an independent determinant of pathological LV remodeling in males, whereas not in females.
There were significant sex differences in the impact of systemic hypertension on LV remodeling in patients with HOCM. Controlled systemic hypertension may contribute to improving LV remodeling in male patients with HOCM, but not in females.
肥厚型梗阻性心肌病（HOCM）合并系统性高血压的临床情况越来越普遍，这带来了具有挑战性的诊断和治疗难题。然而，系统性高血压是否对 HOCM 有影响，以及这种影响是否存在性别差异，尚不清楚。
本研究共纳入 453 例 HOCM 患者（年龄 48.7±12.8 岁，252 例[55.6%]为男性）。其中 150 例（33.1%，81 例男性，69 例女性）有控制良好的系统性高血压病史。所有患者均行心脏磁共振（CMR）成像。通过 CMR 确定左心室（LV）重构指数（LVRI）。LVRI＞1.3 g/mL 定义为病理性 LV 重构。
男性的 LVRI（1.40±0.54 比 1.15±0.38 g/mL，p＜0.001）和 LVRI＞1.3 g/mL（p=0.002）显著大于女性。与无高血压的 HOCM 患者相比，高血压合并 HOCM 患者的晕厥发生率和 5 年心脏性猝死风险评分显著降低。高血压男性的 LVRI（p=0.003）和 LVRI＞1.3 g/mL（p=0.007）显著小于无高血压男性，但高血压女性的 LVRI 和 LVRI＞1.3 g/mL 无显著差异。然而，男性和女性的心肌肌钙蛋白 I 对数和氨基末端 B 型利钠肽前体对数均与 LVRI 呈正相关。多变量逻辑回归分析显示，高血压（OR 0.172，95%CI 0.056-0.528，p=0.002）仍是男性病理性 LV 重构的独立决定因素，而不是女性。
在 HOCM 患者中，系统性高血压对 LV 重构的影响存在显著的性别差异。控制良好的系统性高血压可能有助于改善男性 HOCM 患者的 LV 重构，但对女性患者则不然。
