背景:先前的研究表明,无论采取何种干预措施,患有肥厚型梗阻性心肌病(HCM)的妇女的长期预后较差。然而,根据性别进行酒精间隔消融术(ASA)的患者结局尚未描述.因此,本研究旨在根据性别评估接受ASA的HCM患者的压力变化和长期死亡率.
结果:这是一项单中心回顾性研究,根据性别评估ASA治疗的HCM患者的血流动力学变化和长期死亡率。共纳入259例患者(年龄68.4±11.9岁,62.2%的妇女)。女性在ASA时的年龄和基线压力较高,平均左心房压降低的百分比更大(男性与女性:2.2%与15.9%,分别为;P=0.02)。女性的生存率更高(男性与女性的中位生存率:8.6岁与12.5岁,分别;P=0.011)。关于Cox多变量回归,死亡率的预测因素是年龄(每组变化<60岁,61-70年,71-80岁,和>80岁;危险比[HR],1.45[95%CI,1.10-1.91],P=0.008),女性(HR,0.59[95%CI,0.35-0.99],P=0.048),慢性肾脏病(HR,1.88[95%CI,1.06-3.33],P=0.031),左心室流出道梯度降低≤86%(HR,1.91[95%CI,1.14-3.19],P=0.014)。
结论:与男性相比,接受ASA的HCM女性年龄较大,左侧基线压力较高,但生存率较高。需要进一步的研究来探索在接受ASA的HCM患者中根据性别的不同结果的机制。
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.
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.