Gender-Related Differences in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Trongtorsak, Angkawipa; Polpichai, Natchaya; Thangjui, Sittinun; Kewcharoen, Jakrin; Yodsuwan, Ratdanai; Devkota, Amrit; Friedman, Harvey; Estrada, Alfonso

doi:10.1159/000517618

Cited by 11 publications

(8 citation statements)

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“…This study revealed a significant association between female sex and an elevated risk of all-cause mortality compared to male sex in patients with HCM. These findings are consistent with previous meta-analyses that have reported similar outcomes ( 34 , 37 ). Subgroup analysis based on data matching demonstrated that even within the data matching group where heterogeneity was absent, women continued to exhibit a higher risk of all-cause mortality compared to men.…”

Section: Discussionsupporting

confidence: 93%

“…Two recent meta-analyses have investigated sex disparities in HCM. Angkawipa Trongtorsak et al conducted a comprehensive meta-analysis involving 11 studies and 9,427 HCM patients ( 34 ). Their analysis focused on all-cause mortality, HCM-related mortality, and worsening heart failure or hospitalization due to heart failure as primary outcomes of interest.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review and meta-analysis of sex differences in clinical outcomes of hypertrophic cardiomyopathy

Liu,

Su,

Lang

2023

Front. Cardiovasc. Med.

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BackgroundHypertrophic cardiomyopathy (HCM) is recognized as the most prevalent form of genetic cardiomyopathy, and recent investigations have shed light on the existence of sex disparities in terms of clinical presentation, disease progression, and outcomes.ObjectivesThis study aimed to systematically review the literature and perform a meta-analysis to comprehensively compare the clinical outcomes between female and male patients with HCM.MethodsA thorough search was conducted in databases including PubMed, Embase, Cochrane Library, and Web of Science, encompassing literature from inception until June 2023. The primary endpoints examined were: (1) all-cause mortality; (2) an arrhythmic endpoint comprising sudden cardiac death (SCD), sustained ventricular tachycardia, ventricular fibrillation, or aborted SCD; and (3) a composite endpoint incorporating either (1) or (2), in addition to hospitalization for heart failure or cardiac transplantation. Pooled estimates were derived using a random-effects meta-analysis model.ResultsThe analysis encompassed a total of 29 observational studies, involving 44,677 patients diagnosed with HCM, of which 16,807 were female. Baseline characteristics revealed that the female group exhibited an advanced age [55.66 ± 0.04 years vs. 50.38 ± 0.03 years, pooled mean difference (MD) = 0.31, 95% CI: 0.22–0.40, p = 0.000, I2 = 88.89%], a higher proportion of New York Heart Association class III/IV patients [pooled odds ratio (OR) = 1.94, 95% CI: 1.55–2.43, p = 0.000, I2 = 85.92%], and a greater prevalence of left ventricular outflow tract gradient greater than or equal to 30 mmHg (pooled OR = 1.48, 95% CI: 1.27–1.73, p = 0.000, I2 = 68.88%) compared to the male group. The female group were more likely to have a positive genetic test (pooled OR = 1.27, 95% CI: 1.08–1.48, p = 0.000, I2 = 42.74%) and to carry the myosin heavy chain beta 7 mutation (pooled OR = 1.26, 95% CI: 1.04–1.54, p = 0.020, I2 = 0.00%) compared to the male group. Female sex exhibited a significant association with increased risks of all-cause mortality (pooled OR = 1.62, 95% CI: 1.38–1.89, p = 0.000, I2 = 72.78%) and the composite endpoint (pooled OR = 1.47, 95% CI: 1.20–1.79, p = 0.000, I2 = 84.96%), while no substantial difference was observed in the arrhythmic endpoint (pooled OR = 1.08, 95% CI: 0.87–1.34, p = 0.490, I2 = 55.48%).ConclusionsThe present findings suggest that female patients with HCM tend to experience poorer clinical outcomes. It is imperative to critically reevaluate disease definitions and enhance awareness to mitigate delays in the diagnosis and treatment of HCM in women, thereby fostering equitable healthcare practices.Systematic Review Registrationhttps://www.crd.york.ac.uk/, PROSPERO (CRD42023431881).

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of sex differences in clinical outcomes of hypertrophic cardiomyopathy

Liu,

Su,

Lang

2023

Front. Cardiovasc. Med.

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“…Although a systematic approach to defining PH etiology was not performed in this retrospective assessment, a thorough chart review did not reveal alternative etiologies of PH. There are data showing worse outcomes in females with HCM ( 16 , 17 ), and data herein clarify that this relationship persists in patients with ApHCM ( 7 ).…”

Section: Discussionsupporting

confidence: 63%

Prevalence, sex differences, and implications of pulmonary hypertension in patients with apical hypertrophic cardiomyopathy

Anand,

Covington,

Saraswati

et al. 2024

Front. Cardiovasc. Med.

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IntroductionApical hypertrophic cardiomyopathy (ApHCM) is a subtype of hypertrophic cardiomyopathy (HCM) that affects up to 25% of Asian patients and is not as well understood in non-Asian patients. Although ApHCM has been considered a more “benign” variant, it is associated with increased risk of atrial and ventricular arrhythmias, apical thrombi, stroke, and progressive heart failure. The occurrence of pulmonary hypertension (PH) in ApHCM, due to elevated pressures on the left side of the heart, has been documented. However, the exact prevalence of PH in ApHCM and sex differences remain uncertain.MethodsWe sought to evaluate the prevalence, risk associations, and sex differences in elevated pulmonary pressures in the largest cohort of patients with ApHCM at a single tertiary center. A total of 542 patients diagnosed with ApHCM were identified using ICD codes and clinical notes searches, confirmed by cross-referencing with cardiac MRI reports extracted through Natural Language Processing and through manual evaluation of patient charts and imaging records.ResultsIn 414 patients, echocardiogram measurements of pulmonary artery systolic pressure (PASP) were obtained at the time of diagnosis. The mean age was 59.4 ± 16.6 years, with 181 (44%) being females. The mean PASP was 38 ± 12 mmHg in females vs. 33 ± 9 mmHg in males (p < 0.0001). PH as defined by a PASP value of > 36 mmHg was present in 140/414 (34%) patients, with a predominance in females [79/181 (44%)] vs. males [61/233 (26%), p < 0.0001]. Female sex, atrial fibrillation, diagnosis of congestive heart failure, and elevated filling pressures on echocardiogram remained significantly associated with PH (PASP > 36 mmHg) in multivariable modeling. PH, when present, was independently associated with mortality [hazard ratio 1.63, 95% CI (1.05–2.53), p = 0.028] and symptoms [odds ratio 2.28 (1.40, 3.71), p < 0.001].ConclusionPH was present in 34% of patients with ApHCM at diagnosis, with female sex predominance. PH in ApHCM was associated with symptoms and increased mortality.

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“…Trongtorsak et al . similarly concluded to male predominance in HCM, in their systematic review and meta-analysis [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Hypertrophic Cardiomyopathy in Saudi Arabia: A Systematic Review of the Epidemiological, Clinical, and Imaging Features

Rajab

2023

CCR

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BACKGROUND: A systematic review was performed to deliver a critical view on clinical and research practice on hypertrophic cardiomyopathy (HCM) in Saudi Arabia. Scopus, PubMed, and Google Scholar databases were searched for original articles reporting clinical and/or imaging findings among HCM patients in Saudi Arabia. Of 559 records identified, 3 studies and 1 abstract were included, involving 169 patients. METHOD: The mean ages ranged between 40-56 years, up to 93.3% were males. A family history of HCM was reported in one study (5%), and sudden cardiac death was investigated in two studies (9% and 13%). Where reported, dyspnea was the most frequent symptom (60-68.7%), followed by chest pain (12.5%-73.3%). RESULT: Regarding complications, atrial fibrillation was reported among 0-25% of the patients, mitral regurgitations among 13.3-50%, and ventricular tachycardia among 5-12.5%. Imaging parameters were inadequately documented, and suggested high prevalence of left atrial enlargement, SVI + RV5 > 35 mm, blocks, and asymmetric septal hypertrophy. CONCLUSION: The ejection fraction was reported by two studies with a mean±SD of 68±13% and 77.2±8.07%. The researchers stress the paucity, low quality and disparity in time of original studies about HCM in Saudi Arabia and recommend conducting national multicenter studies, with appropriate design, notably using screening-based recruitment methods.

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Gender-Related Differences in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Cited by 11 publications

References 42 publications

A systematic review and meta-analysis of sex differences in clinical outcomes of hypertrophic cardiomyopathy

A systematic review and meta-analysis of sex differences in clinical outcomes of hypertrophic cardiomyopathy

Prevalence, sex differences, and implications of pulmonary hypertension in patients with apical hypertrophic cardiomyopathy

Hypertrophic Cardiomyopathy in Saudi Arabia: A Systematic Review of the Epidemiological, Clinical, and Imaging Features

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