Clin Res Cardiol (2022).

Sex-related differences in patients with hypertrophic obstructive cardiomyopathy undergoing alcohol septal ablation
D. Lawin1, T. Lawrenz1, K. Marx1, N. B.. Danielsmeier1, M. Poudel1, C. Stellbrink1
1Klinik für Kardiologie und intern. Intensivmedizin, Klinikum Bielefeld Mitte, Bielefeld;

Background: Data on gender-related differences regarding procedure-related aspects and outcome in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing alcohol septal ablation (ASA) are scarce. 

Methods and Results:
 We retrospectively analyzed 1,367 consecutive ASAs between 2002 and 2020 at our institution for gender disparities (47.2% female). Women were older at the timing of ASA (62.8±14.4 vs. 52.8±13.2 years in men; p<0.0001), had a higher degree of symptoms according to the NYHA class (2.8±0.6 vs. 2.5±0.8 in men; p<0.0001) and shorter distances walked in 6-min-walk-test at baseline (357.7±119.9 vs. 457.8±102.3m in men; p<0.0001). Men had higher interventricular septal diameters (IVSD) at baseline (22.0±4.7 vs. 20.7±4.3mm in women; p<0.0001). However, the IVSD was higher in women when it was indexed to the body-surface-area (11.3±2.6 vs. 10.6±2.5mm/m2 in men; p<0.0001). Immediately after ASA the resting and exercise-induced left ventricular outflow tract gradients (LVOTG) were lower in female patients (resting: 30.6±29.7 vs. 32.3±27.4 mmHg in male patients; p=0.0062; exercise-induced: 72.5±52.5 vs. 80.5±50.5mmHg in male patients; p=0.0006). At follow-up after 6 months women had lower exercise-induced LVOTG (53.3±45.3 vs. 56.8±42.6mmHg in men; p=0.0072) but not lower resting LVOTG (22.0±22.6 in women vs. 22.5±20.5mmHg in men; p=n.s.). Persistent high-degree AV block after ASA was more often found in women (20.3% vs. 13.3% in men; p=0.0005) and, thus, more women (17.4%) than men (10.4%; p=0.0002) required a PM after ASA. Mortality was not different between the groups.

 Women treated with ASA for HOCM were older, had more severe symptoms and a higher IVSD when indexed to BSA at the timing of the procedure. Nevertheless, immediate hemodynamic response was better in female patients after ASA while women more often experienced procedure-related high-degree AV block. Sex-related differences in clinical characteristics and procedural outcome of ASA should be taken into consideration.


Figure 1 Baseline absolute interventricular septum diameter (IVSD) in female and male patients treated with ASA. ****=p<0.0001. 


Figure 2 Baseline interventricular septum diameter (IVSD) indexed to body-surface-area using the Mosteller formular in female and male patients treated with ASA. ****=p<0.0001. 


Figure 3 Course of exercise-induced left ventricular outflow tract gradient (LVOTG) calculated at baseline, at short-term follow-up (FU) immediately after ASA and at long-term FU after 6 months. ***=p<0.001. **=p<0.01.