Department of Anesthesiology The Third Hospital of Nanchang, The People's Hospital of Nanchang Nanchang Jiangxi China.
Department of Endocrinology The Second Affiliated Hospital of Nanchang University Nanchang Jiangxi China.
J Am Heart Assoc. 2023 Jun 6;12(11):e026270. doi: 10.1161/JAHA.122.026270. Epub 2023 May 26.
Background It is still unclear whether there is a sex difference in the prognosis of patients with hypertrophic cardiomyopathy (HCM). Therefore, we performed a meta-analysis to elucidate the association between sex and adverse outcomes in patients with HCM. Methods and Results The PubMed, Cochrane Library, and Embase databases were used to search for studies on sex differences in prognosis in patients with HCM up to August 17, 2021. Summary effect sizes were calculated using a random effects model. The protocol was registered in PROSPERO (International prospective register of systematic reviews) (registration number- CRD42021262053). A total of 27 cohorts involving 42 365 patients with HCM were included. Compared with male subjects, female subjects had a higher age at onset (mean difference=5.61 [95% CI, 4.03-7.19]), a higher left ventricular ejection fraction (standard mean difference=0.09 [95% CI, 0.02-0.15]) and a higher left ventricular outflow tract gradient (standard mean difference=0.23 [95% CI, 0.18-0.29]). The results showed that compared with male subjects with HCM, female subjects had higher risks of HCM-related events (risk ratio [RR]=1.61 [95% CI, 1.33-1.94], =49%), major cardiovascular events (RR=3.59 [95% CI, 2.26-5.71], =0%), HCM-related death (RR=1.57 [95% CI, 1.34-1.82], =0%), cardiovascular death (RR=1.55 [95% CI, 1.05-2.28], =58%), noncardiovascular death (RR=1.77 [95% CI, 1.46-2.13], =0%) and all-cause mortality (RR=1.43 [95% CI, 1.09-1.87], =95%), but not atrial fibrillation (RR=1.13 [95% CI, 0.95-1.35], =5%), ventricular arrhythmia (RR=0.88 [95% CI, 0.71-1.10], =0%), sudden cardiac death (RR=1.04 [95% CI, 0.75-1.42], =38%) or composite end point (RR=1.24 [95% CI, 0.96-1.60], =85%). Conclusions Based on current evidence, our results show significant sex-specific differences in the prognosis of HCM. Future guidelines may emphasize the use of a sex-specific risk assessment for the diagnosis and management of HCM.
背景 肥厚型心肌病（HCM）患者的预后是否存在性别差异仍不清楚。因此，我们进行了荟萃分析，以阐明 HCM 患者性别与不良结局之间的关系。
方法和结果 检索了截至 2021 年 8 月 17 日，PubMed、Cochrane Library 和 Embase 数据库中关于 HCM 患者预后性别差异的研究。使用随机效应模型计算汇总效应量。该方案已在 PROSPERO（国际前瞻性系统评价注册库）（注册号-CRD42021262053）中注册。共纳入了 27 项队列研究，涉及 42365 例 HCM 患者。与男性患者相比，女性患者发病年龄更高（平均差异=5.61[95%CI，4.03-7.19]），左心室射血分数更高（标准均数差=0.09[95%CI，0.02-0.15]），左心室流出道梯度更高（标准均数差=0.23[95%CI，0.18-0.29]）。结果表明，与 HCM 男性患者相比，HCM 女性患者发生 HCM 相关事件（风险比[RR]=1.61[95%CI，1.33-1.94]，=49%）、主要心血管事件（RR=3.59[95%CI，2.26-5.71]，=0%）、HCM 相关死亡（RR=1.57[95%CI，1.34-1.82]，=0%）、心血管死亡（RR=1.55[95%CI，1.05-2.28]，=58%）、非心血管死亡（RR=1.77[95%CI，1.46-2.13]，=0%）和全因死亡率（RR=1.43[95%CI，1.09-1.87]，=95%）的风险更高，但心房颤动（RR=1.13[95%CI，0.95-1.35]，=5%）、室性心律失常（RR=0.88[95%CI，0.71-1.10]，=0%）、心源性猝死（RR=1.04[95%CI，0.75-1.42]，=38%）或复合终点（RR=1.24[95%CI，0.96-1.60]，=85%）的风险没有差异。
结论 基于目前的证据，我们的研究结果表明 HCM 患者的预后存在显著的性别差异。未来的指南可能会强调使用基于性别的风险评估来诊断和管理 HCM。
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