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CLINICAL RESEARCH: HYPERTROPHIC AND DILATED CARDIOMYOPATHY

Gender-Related Differences in the Clinical Presentation and Outcome of Hypertrophic Cardiomyopathy

Iacopo Olivotto, MD^_*,_*, Martin S. Maron, MD, A. Selcuk Adabag, MD, Susan A. Casey, RN, Daniela Vargiu, RN^_*, Mark S. Link, MD, James E. Udelson, MD, Franco Cecchi, MD^_* and Barry J. Maron, MD, FACC

^_* Regional Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts-New England Medical Center, Boston, Massachusetts.

Manuscript received December 7, 2004; revised manuscript received January 20, 2005, accepted April 13, 2005.

^_* Reprint requests and correspondence: Dr. Iacopo Olivotto, Cardiologia San Luca, Azienda Ospedaliera Universitaria Careggi, Viale Pieraccini 17, 50132, Firenze, Italy. (Email: olivottoi{at}ao-careggi.toscana.it).

OBJECTIVES: The goal of this study was to assess gender-related differences in a multicenter population with hypertrophic cardiomyopathy (HCM).

BACKGROUND: Little is known regarding the impact of gender on the heterogeneous clinical profile and clinical course of HCM.

METHODS: We studied 969 consecutive HCM patients from Italy and the U.S. followed over 6.2 ± 6.1 years.

RESULTS: Male patients had a 3:2 predominance (59%), similar in Italy and the U.S. (p = 0.24). At initial evaluation, female patients were older and more symptomatic than male patients (47 ± 23 years vs. 38 ± 18 years; p < 0.001; mean New York Heart Association [NYHA] functional class 1.8 ± 0.8 vs. 1.4 ± 0.6; p < 0.001), and more frequently showed left ventricular outflow obstruction (37% vs. 23%; p < 0.001). Moreover, female patients were less often diagnosed fortuitously by routine medical examination (23% vs. 41% in male patients, p < 0.001). Female gender was independently associated with the risk of symptom progression to NYHA functional classes III/IV or death from heart failure or stroke compared with male gender (independent relative hazard 1.5; p < 0.001), particularly patients 50 years of age and with resting outflow obstruction (p < 0.005). Hypertrophic cardiomyopathy-related mortality and risk of sudden death were similar in men and women.

CONCLUSIONS: Women with HCM were under-represented, older, and more symptomatic than men, and showed higher risk of progression to advanced heart failure or death, often associated with outflow obstruction. These gender-specific differences suggest that social, endocrine, or genetic factors may affect the diagnosis and clinical course of HCM. A heightened suspicion for HCM in women may allow for timely implementation of treatment strategies, including relief of obstruction and prevention of sudden death or stroke.

Abbreviations and Acronyms   HCM = hypertrophic cardiomyopathy   ICD = implanted cardioverter-defibrillator   LV = left ventricle/ventricular   NYHA = New York Heart Association

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