Comprehensive Heart Failure Center (CHFC), University Clinic, Wuerzburg, Germany; Medizinische Klinik 1, Leopoldina-Krankenhaus, Schweinfurt, Germany.
Medizinische Klinik 1, Leopoldina-Krankenhaus, Schweinfurt, Germany.
Int J Cardiol. 2021 Apr 1;328:117-121. doi: 10.1016/j.ijcard.2020.12.039. Epub 2020 Dec 31.
Sex-related differences in diagnosis and treatment of hypertrophic obstructive cardiomyopathy (HOCM) are still unclear. Therefore, we analyzed baseline characteristics of symptomatic patients with indication for alcohol septal ablation (PTSMA) with respect to gender.
Between 05/2000 and 06/2017 indication for PTSMA was seen in 1014 patients (420 (41.4%) women and 594 (58.6%) men). Women were older (61.4 ± 15.0 vs. 51.8 ± 13.6 years; p < 0.00001) and suffered more often from dyspnea NYHA III/IV (81.4% vs. 67.7%; p < 0.001), whereas angina pectoris and syncopes were comparable. Echocardiographic gradients were comparable in women (66.4 ± 39.1 mmHg at rest and 106.5 ± 46.6 mmHg at Valsalva) and men (62.7 ± 38.8 mmHg at rest and 103.7 ± 42.7 mmHg at Valsalva). Women had smaller absolute diameter of the left atrium (LA) (44.4 ± 6.9 vs. 47.2 ± 6.5 mm; p < 0.0001), septal thickness (IVS) (20.5 ± 4.1 vs. 21.4 ± 4.5 mm; p < 0.01), and left ventricular posterior wall thickness (LVPW) (12.7 ± 2.8 vs. 13.6 ± 2.9 mm; p < 0.0001). But, indexed for BSA the relationship reversed in LA (25.2 ± 4.3 mm/m in women vs. 23.1 ± 3.4 mm/m), IVS (11.7 ± 2.7 mm/m in women vs. 10.6 ± 2.5 mm/m) and LVPW (7.3 ± 1.7 mm/m in women vs. 6.7 ± 1.6 mm/m), p < 0.00001 each.
Women with HOCM and indication for PTSMA are older and more symptomatic with advanced disease progression. Reconsideration of disease definition and awareness maybe necessary in order to avoid delayed diagnosis and treatment of HOCM in women.
在肥厚型梗阻性心肌病（HOCM）的诊断和治疗方面，性别相关的差异仍不清楚。因此，我们分析了有酒精室间隔消融术（PTSMA）适应证的症状性患者的基线特征，分析了其与性别相关的差异。
2000 年 5 月至 2017 年 6 月期间，共有 1014 例患者（420 例女性和 594 例男性）有 PTSMA 适应证。女性年龄更大（61.4 ± 15.0 岁 vs. 51.8 ± 13.6 岁；p < 0.00001），更常出现 NYHA III/IV 级呼吸困难（81.4% vs. 67.7%；p < 0.001），而心绞痛和晕厥的发生率相似。女性和男性的超声心动图梯度相似（静息时分别为 66.4 ± 39.1mmHg 和 62.7 ± 38.8mmHg，valsalva 时分别为 106.5 ± 46.6mmHg 和 103.7 ± 42.7mmHg）。女性的左心房（LA）绝对直径（44.4 ± 6.9mm vs. 47.2 ± 6.5mm；p < 0.0001）、室间隔厚度（IVS）（20.5 ± 4.1mm vs. 21.4 ± 4.5mm；p < 0.01）和左心室后壁厚度（LVPW）（12.7 ± 2.8mm vs. 13.6 ± 2.9mm；p < 0.0001）更小。但经体表面积校正后，LA（女性 25.2 ± 4.3mm/m vs. 男性 23.1 ± 3.4mm/m）、IVS（女性 11.7 ± 2.7mm/m vs. 男性 10.6 ± 2.5mm/m）和 LVPW（女性 7.3 ± 1.7mm/m vs. 男性 6.7 ± 1.6mm/m）的关系发生逆转，p 值均<0.0001。
有 PTSMA 适应证的 HOCM 女性年龄更大，症状更严重，疾病进展更严重。为了避免女性 HOCM 的诊断和治疗延迟，可能需要重新考虑疾病的定义和认识。
