Sex-related differences in symptomatic patients with hypertrophic obstructive cardiomyopathy - Time for a new definition?

Introduction: Sex-related differences in diagnosis and treatment of hypertrophic obstructive cardiomyopathy (HOCM) are still unclear. Therefore, we analyzed baseline characteristics of symptomatic patients with indication for alcohol septal ablation (PTSMA) with respect to gender.

Methods And Results: Between 05/2000 and 06/2017 indication for PTSMA was seen in 1014 patients (420 (41.4%) women and 594 (58.6%) men). Women were older (61.4 ± 15.0 vs. 51.8 ± 13.6 years; p < 0.00001) and suffered more often from dyspnea NYHA III/IV (81.4% vs. 67.7%; p < 0.001), whereas angina pectoris and syncopes were comparable. Echocardiographic gradients were comparable in women (66.4 ± 39.1 mmHg at rest and 106.5 ± 46.6 mmHg at Valsalva) and men (62.7 ± 38.8 mmHg at rest and 103.7 ± 42.7 mmHg at Valsalva). Women had smaller absolute diameter of the left atrium (LA) (44.4 ± 6.9 vs. 47.2 ± 6.5 mm; p < 0.0001), septal thickness (IVS) (20.5 ± 4.1 vs. 21.4 ± 4.5 mm; p < 0.01), and left ventricular posterior wall thickness (LVPW) (12.7 ± 2.8 vs. 13.6 ± 2.9 mm; p < 0.0001). But, indexed for BSA the relationship reversed in LA (25.2 ± 4.3 mm/m in women vs. 23.1 ± 3.4 mm/m), IVS (11.7 ± 2.7 mm/m in women vs. 10.6 ± 2.5 mm/m) and LVPW (7.3 ± 1.7 mm/m in women vs. 6.7 ± 1.6 mm/m), p < 0.00001 each.

Conclusion: Women with HOCM and indication for PTSMA are older and more symptomatic with advanced disease progression. Reconsideration of disease definition and awareness maybe necessary in order to avoid delayed diagnosis and treatment of HOCM in women.