Structural and Functional Remodeling and Long-Term Outcomes in Women With Hypertrophic Cardiomyopathy

Area of Science:

• Cardiology
• Cardiovascular Research
• Medical Science

Background:

• Sex-related differences in hypertrophic cardiomyopathy (HCM) are increasingly recognized.
• Women are underrepresented in most HCM cohorts, limiting understanding of sex-specific characteristics.
• This study addresses the need to characterize sex-specific differences in HCM.

Purpose of the Study:

• To characterize sex-specific differences in clinical features of HCM.
• To investigate sex-specific differences in myocardial mechanics.
• To analyze sex-specific long-term outcomes in patients with HCM.

Main Methods:

• A cohort of 501 patients with HCM was evaluated.
• 181 (36%) of the patients were women.
• Comprehensive clinical and echocardiographic data were collected, with survival and event-free outcomes assessed over a median follow-up of 6.23 years.

Main Results:

• Women with HCM had smaller left ventricular (LV) dimensions and lower LV mass index (LVMI) compared to men.
• Women exhibited higher E/E' ratio, increased pulmonary artery systolic pressure, reduced global longitudinal strain (GLS), and lower early diastolic strain rate (SRe).
• Hospitalizations for heart failure, arrhythmias, or stroke were more frequent in women (34.4% vs. 24.4%), despite women being less symptomatic.

Conclusions:

• Women with HCM display distinct structural and mechanical features, including smaller ventricular size, lower LV mass, higher filling pressures, and impaired myocardial deformation.
• These sex-specific differences are associated with increased morbidity.
• The findings support the need for sex-specific diagnostic thresholds and individualized management strategies for women with HCM.