Survival Differences in Women and Men After Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy.

Published on Mar 1, 2019in JAMA Cardiology14.676
· DOI :10.1001/JAMACARDIO.2019.0084
Zahara Meghji5
Estimated H-index: 5
(Mayo Clinic),
Anita Nguyen10
Estimated H-index: 10
(Mayo Clinic)
+ 6 AuthorsHartzell V. Schaff132
Estimated H-index: 132
(Mayo Clinic)
Sources
Abstract
Importance Recent data indicate that women with hypertrophic cardiomyopathy (HCM) are older and more symptomatic at presentation and have worse clinical outcomes than men. However, to our knowledge, there are no large studies of the association of patient sex with outcomes after surgical myectomy. Objective To analyze preoperative characteristics and overall survival of women and men undergoing septal myectomy for obstructive HCM. Design, Setting, and Participants This retrospective, single-center study included the clinical data of adult patients who underwent septal myectomy from January 1961 through April 2016. Data analysis occurred from December 2017 to December 2018. Exposures Septal myectomy. Main Outcomes and Measures Survival. Results A total of 2506 adults were included; 1379 patients (55.0%) were men. At the time of surgery, women were older, with median (IQR) age of 59.5 (46.6-68.2) years vs 52.9 (42.9-62.7) years in men (P  Conclusions and Relevance In this large cohort of surgical patients with obstructive HCM, we observed significant differences at clinical presentation between women and men, in that women were older and more symptomatic. However, after adjustment for important baseline prognostic factors, there was no survival difference after septal myectomy by sex. Improved care of women with obstructive HCM should focus on early identification of disease and prompt surgical referral of appropriate patients who do not respond to medical treatment.
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Background In patients with hypertrophic cardiomyopathy (HCM), enlargement of the left atrium (LA) is associated with increased morbidity and mortality because of risk of atrial fibrillation (AF), stroke, and heart failure. In this study, we investigated whether LA reverse remodeling occurs after septal myectomy. Methods Between August 2007 and July 2015, 656 patients underwent myectomy at our institution and had preoperative and postoperative transthoracic echocardiographic (TTE) recording of L...
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Treatment of progressive heart failure, due to left ventricular (LV) outflow tract obstruction and elevated intraventricular systolic pressures, has been a major component of hypertrophic cardiomyopathy (HCM) disease management for 50 years [(1–3)][1]. Throughout this time, septal myectomy has
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For over 50 years, surgical septal myectomy has been the preferred treatment for drug-refractory heart failure symptoms in obstructive hypertrophic cardiomyopathy (HCM). However, given the relatively youthful adult ages at which HCM surgery is usually performed, it is informative to evaluate longer-term results of myectomy after ≥10 years. We identified 139 consecutive obstructive HCM patients (50 ± 15 years of age; 55% men) who underwent surgical myectomy, 2003 to 2010 at Tufts HCM Center and f...
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Hypertrophic cardiomyopathy (HCM) is a common inherited heart disease with an estimated prevalence of up to 1 in 200 individuals. In the majority of cases, HCM is considered a Mendelian disease, with mainly autosomal dominant inheritance. Most pathogenic variants are usually detected in genes for sarcomeric proteins. Nowadays, the genetic basis of HCM is believed to be rather complex. Thousands of mutations in more than 60 genes have been described in association with HCM. Nevertheless, screenin...
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