Sex-Related Differences in Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation
Mohamad S Alabdaljabar1, Mohamed Elhadi1, Jeffrey B Geske2
1Department of Internal Medicine Mayo Clinic Rochester MN.
Insights
Women with hypertrophic obstructive cardiomyopathy (HCM) undergoing alcohol septal ablation (ASA) are older but experience better survival rates. This study highlights sex-based differences in outcomes following ASA for HCM patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Previous research indicates poorer long-term outcomes for women with hypertrophic obstructive cardiomyopathy (HCM).
- Outcomes following alcohol septal ablation (ASA) stratified by sex in HCM patients remain underexplored.
- This study addresses the gap in understanding sex-specific outcomes after ASA for HCM.
Purpose of the Study:
- To compare hemodynamic changes in patients with HCM undergoing ASA, stratified by sex.
- To evaluate long-term mortality differences between men and women with HCM after ASA.
- To identify predictors of mortality in HCM patients treated with ASA.
Main Methods:
- A single-center retrospective study design.
- Inclusion of 259 patients (62.2% women) who underwent ASA for HCM.
- Analysis of hemodynamic parameters and long-term survival data, with Cox multivariable regression for mortality predictors.
Main Results:
- Women were older and had higher baseline pressures at the time of ASA compared to men.
- Women showed a significantly greater percent reduction in mean left atrial pressure post-ASA (15.9% vs 2.2%).
- Women experienced significantly better long-term survival (12.5 years) compared to men (8.6 years).
Conclusions:
- Despite being older and having higher baseline pressures, women with HCM undergoing ASA demonstrate superior survival rates.
- Female sex emerged as an independent predictor of better survival in the Cox multivariable regression.
- Further research is warranted to elucidate the underlying mechanisms driving these sex-based outcome disparities in HCM patients treated with ASA.
Background:
Previous studies have shown that women with hypertrophic obstructive cardiomyopathy (HCM) have worse long-term outcomes irrespective of intervention. However, the outcomes of patients undergoing alcohol septal ablation (ASA) based on sex have not been described. Hence, this study aimed to evaluate pressure changes and long-term mortality in patients with HCM undergoing ASA based on sex.
Methods And Results:
This is a single-center retrospective study evaluating hemodynamic changes and long-term mortality in patients with HCM treated with ASA according to sex. A total of 259 patients were included (aged 68.4±11.9 years, 62.2% women). Women had higher age and baseline pressures at the time of ASA, with a greater percent reduction in mean left atrial pressure (men versus women: 2.2% versus 15.9%, respectively; P=0.02). Women had better survival (median survival rate of men versus women: 8.6 versus 12.5 years, respectively; P=0.011). On Cox multivariable regression, predictors of mortality were age (per group change <60 years, 61-70 years, 71-80 years, and >80 years; hazard ratio [HR], 1.45 [95% CI, 1.10-1.91], P=0.008), female sex (HR, 0.59 [95% CI, 0.35-0.99], P=0.048), chronic kidney disease (HR, 1.88 [95% CI, 1.06-3.33], P=0.031), and left ventricular outflow tract gradient reduction ≤86% (HR, 1.91 [95% CI, 1.14-3.19], P=0.014).
Conclusions:
Women with HCM undergoing ASA are older and have higher left-sided baseline pressures compared with men yet have better survival. Further studies exploring the mechanisms of differential outcomes according to sex in patients with HCM undergoing ASA are needed.
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