Cardiovascular Center, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea.
Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2022 Feb 25;17(2):e0264580. doi: 10.1371/journal.pone.0264580. eCollection 2022.
We aimed to clarify the sex differences in various cardiovascular and non-cardiovascular outcomes, and to investigate whether sex differences in outcomes are affected by age in hypertrophic cardiomyopathy (HCM).
A cohort of 835 patients with HCM initially evaluated during 2007-2019 were followed for a median of 6.4 years. Study outcomes were all-cause death, cardiovascular and non-cardiovascular death, sudden cardiac death (SCD)/SCD equivalent events, heart failure (HF) events, and the composite cardiovascular outcome including cardiovascular death, SCD/SCD equivalent events, admission for HF, and heart transplantation.
Women were 5 years older (women 59.9±13.5 vs. men 54.9±11.4 years), had worse dyspnea, and greater left ventricular (LV) diastolic dysfunction and obstructive physiology at presentation. Women compared to men had higher all-cause mortality and cardiovascular event rates, driven by more cardiovascular deaths and heart failure (HF) events. Conversely, non-cardiovascular mortality was not different between the sexes. Female sex was independently associated with all-cause death (HR 1.88, 95% CI 1.11-3.20) and composite cardiovascular events (HR 3.60, 95% CI 2.00-6.49), independent of age, body mass index, New York Heart Association class, SCD risk score, and LV ejection fraction. When stratified by the age of 60, sex differences were not significant at <60 years; however, at ≥60 years, women had worse LV diastolic function, greater obstructive physiology, as well as worse survival and composite cardiovascular outcomes. Sex differences in outcomes remained consistent after propensity score matching for age and other clinical characteristics.
Women with HCM have worse cardiovascular prognosis than men, driven by higher cardiovascular mortality and HF events. The negative impact of female sex on cardiac function and cardiovascular outcome became prominent at age ≥60 years, suggesting age-related sex differences in the prognosis of HCM.
我们旨在阐明肥厚型心肌病（HCM）患者中不同心血管和非心血管结局的性别差异，并探讨结局的性别差异是否受年龄影响。
对 2007 年至 2019 年间初次评估的 835 例 HCM 患者进行了队列研究，中位随访时间为 6.4 年。研究结局包括全因死亡、心血管死亡和非心血管死亡、心源性猝死（SCD）/SCD 等效事件、心力衰竭（HF）事件以及包括心血管死亡、SCD/SCD 等效事件、HF 入院和心脏移植在内的复合心血管结局。
女性患者比男性患者年长 5 岁（女性 59.9±13.5 岁 vs. 男性 54.9±11.4 岁），呼吸困难更严重，左心室（LV）舒张功能和梗阻性生理特征更差。与男性相比，女性的全因死亡率和心血管事件发生率更高，这主要归因于心血管死亡和 HF 事件更多。相反，男女之间的非心血管死亡率没有差异。女性性别与全因死亡（HR 1.88，95%CI 1.11-3.20）和复合心血管事件（HR 3.60，95%CI 2.00-6.49）独立相关，与年龄、体重指数、纽约心脏协会心功能分级、SCD 风险评分和 LV 射血分数无关。按 60 岁分层，<60 岁时性别差异不显著；然而，≥60 岁时，女性的 LV 舒张功能更差，梗阻性生理特征更明显，生存和复合心血管结局更差。经年龄和其他临床特征倾向评分匹配后，结局的性别差异仍然一致。
与男性相比，女性 HCM 患者的心血管预后更差，这主要归因于心血管死亡率和 HF 事件更高。女性性别对心功能和心血管结局的负面影响在年龄≥60 岁时变得明显，提示 HCM 预后存在与年龄相关的性别差异。
