梗阻性肥厚型心肌病中女性死亡率过高的相关因素。

Factors associated with excess female mortality in obstructive hypertrophic cardiomyopathy.

作者信息

Javidgonbadi Davood, Schaufelberger Maria, Östman-Smith Ingegerd

机构信息

Department of Cardiology, Northern Älvsborg County Hospital, Trollhättan, Sweden.

Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.

出版信息

Eur J Prev Cardiol. 2022 Aug 22;29(11):1545-1556. doi: 10.1093/eurjpc/zwac078.

DOI:10.1093/eurjpc/zwac078

PMID:35512246

Abstract

BACKGROUND

Several studies have reported excess female mortality in patients with hypertrophic cardiomyopathy, but the cause is unknown.

AIMS

To compare risk-factors for disease-related death in both sexes in a geographical cohort of patients with obstructive hypertrophic cardiomyopathy (oHCM).

METHODS AND RESULTS

Data-bases in all ten hospitals within West Götaland Region yielded 250 oHCM-patients (123 females, 127 males). Mean follow-up was 18.1 y. Risk-factors for disease-related death were evaluated by Cox-hazard regression and Kaplan-Meier survival-curves, with sex-comparisons of distribution of risk-factors and therapy in total and age-matched (n = 166) groups. At diagnosis females were older, median 62 y vs. 51 y, (P < 0.001), but not different in outflow-gradients and median NYHA-class. However, septal hypertrophy was more advanced: 10.6 [IQR = 3.2] vs. 9.6 [2.5] mm/m2 BSA; P = 0.002. Females had higher disease-related mortality than males (P = <0.001), with annual mortality 2.9% vs. 1.5% in age-matched groups (P = 0.010 log-rank). For each risk-category identified (NYHA-class ≥ III, outflow-gradient ≥50 mmHg), a higher proportion of females died (P = 0.0004; P = 0.001). Calcium-blocker therapy was a risk-factor (P = 0.005) and was used more frequently in females (P = 0.034). A beta-blocker dose above cohort-median reduced risk for disease-related death in both males (HR = 0.32; P = 0.0040) and in females (HR = 0.49; P = 0.020). Excess female deaths occurred in chronic heart-failure (P = 0.001) and acute myocardial infarctions (P = 0.015). Fewer females received beta-blocker therapy after diagnosis (64% vs. 78%, P = 0.018), in a smaller dose (P = 0.007), and less frequently combined with disopyramide (7% vs. 16%, P = 0.048).

CONCLUSION

Addressing sex-disparities in the timing of diagnosis and pharmacological therapy has the potential to improve the care of females with oHCM.

摘要

背景

多项研究报告了肥厚型心肌病患者中女性死亡率过高的情况，但其原因尚不清楚。

目的

比较梗阻性肥厚型心肌病（oHCM）患者地理队列中两性疾病相关死亡的危险因素。

方法与结果

韦斯特罗斯地区所有十家医院的数据库提供了250例oHCM患者（123例女性，127例男性）。平均随访时间为18.1年。通过Cox风险回归和Kaplan-Meier生存曲线评估疾病相关死亡的危险因素，并对总体和年龄匹配组（n = 166）中危险因素和治疗的分布进行性别比较。诊断时女性年龄较大，中位数为62岁，而男性为51岁（P < 0.001），但流出道梯度和纽约心脏协会（NYHA）分级中位数无差异。然而，室间隔肥厚更严重：10.6 [四分位间距（IQR）= 3.2] 与9.6 [2.5] mm/m²体表面积；P = 0.002。女性的疾病相关死亡率高于男性（P = <0.001），年龄匹配组的年死亡率分别为2.9%和1.5%（P = 0.010对数秩检验）。对于确定的每个风险类别（NYHA分级≥III级，流出道梯度≥50 mmHg），死亡的女性比例更高（P = 0.0004；P = 0.001）。钙通道阻滞剂治疗是一个危险因素（P = 0.005），在女性中使用更频繁（P = 0.034）。β受体阻滞剂剂量高于队列中位数可降低男性（风险比[HR]=0.32；P = 0.0040）和女性（HR = 0.49；P = 0.020）疾病相关死亡的风险。女性死亡过多发生在慢性心力衰竭（P = 0.001）和急性心肌梗死（P = 0.015）中。诊断后接受β受体阻滞剂治疗的女性较少（64%对78%，P = 0.018），剂量较小（P = 0.007），与丙吡胺联合使用的频率较低（7%对16%，P = 0.048）。