汉族人群肥厚型梗阻性心肌病酒精室间隔消融术后临床结局的性别差异：一项队列研究。
Gender Disparities in Clinical Outcome After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy in the Chinese Han Population: A Cohort Study.
机构信息
Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning Province, P. R. China.
Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning Province, P. R. China.
出版信息
Heart Lung Circ. 2020 Dec;29(12):1856-1864. doi: 10.1016/j.hlc.2020.04.014. Epub 2020 Jun 11.
BACKGROUND
Sex differences in the long-term prognosis of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing alcohol septal ablation (ASA) remain unclear, especially in the Chinese Han population.
METHOD
This cohort study included 320 HOCM Chinese Han patients who underwent ASA because of symptomatic left ventricular outflow tract (LVOT) obstruction. Patients were grouped according to sex: females (mean±standard deviation age [SD] 50.7±6.8 years) and males (mean±SD age 52.6±7.3 years). Individuals were followed over the long term.
RESULTS
Pre-procedure, women had more symptoms (New York Heart Association [NYHA] class III-IV 67.3% vs 56.3%, p=0.03), more atrial fibrillation (23.5% vs 14.6%, p=0.047) than men. Transient complete atrioventricular block after ASA was more common in woman than in men (34.0 vs 23.4%; p=0.048). Residual LVOT gradient, post-procedural residual left ventricular wall thickness, NYHA functional class, and adverse arrhythmic events were comparable between the two groups. The 10-year survival rate (77% vs 89%, p=0.037) and the annual adverse arrhythmic event rate (1.3% vs 0.4%, p<0.01) following ASA were significantly worse in women compared with men. Kaplan-Meier analysis showed a significantly lower survival in women compared with men (p=0.023). In multivariable modelling, female sex remained independently associated with higher all-cause mortality (hazard ratio, 1.12; 95% confidence interval, 1.08-1.27; p=0.03) when adjusted for age, NYHA class III-IV symptoms, and other cardiovascular comorbidities.
CONCLUSIONS
Female patients with HOCM undergoing ASA tended to have more severe symptoms and adverse arrhythmic events. The 10-year survival rate after ASA was significantly worse in women compared with men with HOCM. Sex may need to be considered as an important factor in the clinical management of patients with symptomatic HOCM.
背景
接受酒精室间隔消融术（ASA）的有症状肥厚型梗阻性心肌病（HOCM）患者的长期预后存在性别差异，但这在汉族人群中仍不清楚。
方法
本队列研究纳入了 320 名因左心室流出道（LVOT）梗阻而接受 ASA 的汉族 HOCM 患者。根据性别将患者分为两组：女性（平均年龄[SD]为 50.7±6.8 岁）和男性（平均年龄为 52.6±7.3 岁）。对个体进行长期随访。
结果
术前，女性的症状更多（纽约心脏协会[NYHA]心功能分级 III-IV 级为 67.3%，而男性为 56.3%，p=0.03），心房颤动更多（23.5%，而男性为 14.6%，p=0.047）。ASA 后，女性发生一过性完全性房室传导阻滞比男性更常见（34.0%，而男性为 23.4%，p=0.048）。两组间 LVOT 残余梯度、术后残余左心室壁厚度、NYHA 心功能分级和不良心律失常事件相当。ASA 后，女性 10 年生存率（77%，而男性为 89%，p=0.037）和每年不良心律失常事件发生率（1.3%，而男性为 0.4%，p<0.01）均显著低于男性。Kaplan-Meier 分析显示，女性的生存率明显低于男性（p=0.023）。多变量模型显示，在校正年龄、NYHA 心功能分级 III-IV 症状和其他心血管合并症后，女性性别仍然与全因死亡率升高独立相关（危险比，1.12；95%置信区间，1.08-1.27；p=0.03）。
结论
接受 ASA 的女性 HOCM 患者往往症状更严重，心律失常事件更多。与男性 HOCM 患者相比，ASA 后女性 10 年生存率显著降低。性别可能需要被视为治疗有症状 HOCM 患者的临床管理中的一个重要因素。
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