Nie Changrong, Zhu Yifeng, Xiao Minghu, Zhu Changsheng, Meng Yanhai, Lu Zhengyang, Yang Qiulan, Wang Shuiyun
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of General Medical Intensive Care Unit, Shaoxing People's Hospital, No.568 North Zhongxing Road, Shaoxing 312000, Zhejiang Province, China.
Int J Cardiol Heart Vasc. 2024 Nov 26;56:101569. doi: 10.1016/j.ijcha.2024.101569. eCollection 2025 Feb.
Pulmonary hypertension (PH) and female have been linked to a worse survival in patients with obstructive hypertrophic cardiomyopathy (oHCM). However, female patients with PH exhibited a better prognosis than males. Herein, we investigated sex differences in the prevalence and survival of pH in oHCM following septal myectomy.
We consecutively enrolled 1491 patients diagnosed with oHCM. PH was defined as a pulmonary artery systolic pressure (PASP) > 36 mm Hg.
Females were older, more likely to experience chest pain and NYHA class III/IV symptoms, and had a higher prevalence of PH (37.6 % vs. 19.9 %, p < 0.001) than males. Multivariable analysis showed that female was an independent risk for PH (OR 2.3, 95 % CI: 1.70-3.11, p < 0.001) though the PASP was comparable between males and females (44.93 ± 10.87 vs. 44.74 ± 9.72 mm Hg, p = 0.856). Over a median follow-up of 36 months [IQR 23.5-52.5 months), 28 deaths and 189 composite endpoints were observed. Kaplan-Meier analysis showed a higher cumulative incidence of death (p = 0.015) and composite endpoints (p < 0.001) in patients with PH, and Cox regression analysis revealed that PH (HR 1.78, 95 % CI: 1.30-2.45, p < 0.001) and female (HR 1.39, 95 % CI: 1.02-1.90, p = 0.038) were independently associated with composite endpoints. However, no significant survival differences were found between males and females within the PH subgroup.
Female was independently associated with higher prevalence but not severity of PH. Although PH and female were independently associated with worse survival, no survival difference was found between males and females in the PH subgroup.
肺动脉高压（PH）与女性梗阻性肥厚型心肌病（oHCM）患者生存率较低有关。然而，患有PH的女性患者预后比男性更好。在此，我们研究了间隔心肌切除术后oHCM患者中PH患病率和生存率的性别差异。
我们连续纳入了1491例诊断为oHCM的患者。PH定义为肺动脉收缩压（PASP）>36mmHg。
女性年龄更大，更易出现胸痛和纽约心脏协会（NYHA）III/IV级症状，且PH患病率高于男性（37.6%对19.9%，p<0.001）。多变量分析显示，女性是PH的独立危险因素（比值比2.3，95%置信区间：1.70 - 3.11，p<0.001），尽管男性和女性之间的PASP相当（44.93±10.87对44.74±9.72mmHg，p = 0.856）。在中位随访36个月[四分位间距23.5 - 52.5个月]期间，观察到28例死亡和189个复合终点事件。Kaplan - Meier分析显示，PH患者的累积死亡率（p = 0.015）和复合终点事件发生率（p<0.001）更高，Cox回归分析显示，PH（风险比1.78，95%置信区间：1.30 - 2.45，p<0.001）和女性（风险比1.39，95%置信区间：1.02 - 1.90，p = 0.038）与复合终点事件独立相关。然而，在PH亚组中，男性和女性之间未发现显著的生存差异。
女性与较高的PH患病率独立相关，但与PH严重程度无关。尽管PH和女性均与较差的生存率独立相关，但在PH亚组中，男性和女性之间未发现生存差异。
