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Gender Disparities in Clinical Outcome After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy in
Yong Wang1, Hong-Wei Zhao1, Cheng-Fu Wang1
1Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, Liaoning Province, P. R. China.
Insights
Women with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA) experience worse long-term survival and more adverse events. These findings suggest sex is a critical factor in managing HOCM patients post-ASA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Prognosis
Background:
- Long-term outcomes of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients after alcohol septal ablation (ASA) show unclear sex-based differences, particularly in the Chinese Han population.
- Understanding these sex differences is crucial for personalized HOCM management.
Purpose of the Study:
- To investigate the sex-specific long-term prognosis of symptomatic HOCM patients following ASA.
- To identify potential sex-based disparities in outcomes and adverse events after ASA in this population.
Main Methods:
- A cohort study involving 320 symptomatic HOCM Chinese Han patients who underwent ASA for left ventricular outflow tract (LVOT) obstruction.
- Patients were stratified by sex and followed long-term, with analysis of pre-procedure symptoms, procedural complications, and long-term survival rates.
Main Results:
- Female patients presented with more severe symptoms (NYHA class III-IV) and higher rates of atrial fibrillation pre-procedure.
- While procedural complications like atrioventricular block were more frequent in women, key outcomes such as residual LVOT gradient and NYHA class were comparable.
- Women experienced significantly worse 10-year survival rates (77% vs. 89%) and higher annual adverse arrhythmic event rates (1.3% vs. 0.4%) post-ASA. Female sex was an independent predictor of higher all-cause mortality.
Conclusions:
- Female HOCM patients undergoing ASA exhibit a poorer long-term prognosis, characterized by more severe symptoms, increased adverse arrhythmic events, and reduced survival rates.
- Sex is a significant factor influencing the clinical management and long-term outcomes of HOCM patients treated with ASA.
- Further research and tailored clinical strategies considering sex differences are warranted for optimizing HOCM patient care.
Background:
Sex differences in the long-term prognosis of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing alcohol septal ablation (ASA) remain unclear, especially in the Chinese Han population.
Method:
This cohort study included 320 HOCM Chinese Han patients who underwent ASA because of symptomatic left ventricular outflow tract (LVOT) obstruction. Patients were grouped according to sex: females (mean±standard deviation age [SD] 50.7±6.8 years) and males (mean±SD age 52.6±7.3 years). Individuals were followed over the long term.
Results:
Pre-procedure, women had more symptoms (New York Heart Association [NYHA] class III-IV 67.3% vs 56.3%, p=0.03), more atrial fibrillation (23.5% vs 14.6%, p=0.047) than men. Transient complete atrioventricular block after ASA was more common in woman than in men (34.0 vs 23.4%; p=0.048). Residual LVOT gradient, post-procedural residual left ventricular wall thickness, NYHA functional class, and adverse arrhythmic events were comparable between the two groups. The 10-year survival rate (77% vs 89%, p=0.037) and the annual adverse arrhythmic event rate (1.3% vs 0.4%, p<0.01) following ASA were significantly worse in women compared with men. Kaplan-Meier analysis showed a significantly lower survival in women compared with men (p=0.023). In multivariable modelling, female sex remained independently associated with higher all-cause mortality (hazard ratio, 1.12; 95% confidence interval, 1.08-1.27; p=0.03) when adjusted for age, NYHA class III-IV symptoms, and other cardiovascular comorbidities.
Conclusions:
Female patients with HOCM undergoing ASA tended to have more severe symptoms and adverse arrhythmic events. The 10-year survival rate after ASA was significantly worse in women compared with men with HOCM. Sex may need to be considered as an important factor in the clinical management of patients with symptomatic HOCM.
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