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

<b><i>Background:</i></b> Gender-related differences in phenotypic expression and outcomes have been established in many cardiac conditions; however, the impact of gender in hypertrophic cardiomyopathy (HCM) remains unclear. We conducted a systematic review and meta-analysis to assess the differences in clinical outcomes between female and male HCM patients. <b><i>Methods:</i></b> We searched MEDLINE and EMBASE from inception to October 2020. Included were cohort studies that compared outcomes of interest including all-cause mortality, HCM-related mortality, and worsening heart failure (HF) or HF hospitalization between male and female. Data from each study were combined using the random effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI). <b><i>Results:</i></b> Eleven retrospective cohort studies with a total of 9,427 patients (3,719 females) were included. Female gender was significantly associated with an increased risk of all-cause mortality (pooled OR = 1.63, 95% CI: 1.26–2.10, <i>p</i> ≤ 0.001), HCM-related mortality (pooled OR = 1.47, 95% CI: 1.08–2.01, <i>p</i> = 0.015), and worsening HF or HF hospitalization (pooled OR = 2.05, 95% CI: 1.76–2.39, <i>p</i> ≤ 0.001). <b><i>Conclusions:</i></b> Female gender was associated with a worse prognosis in HCM. These findings suggest the need for improved care in women including early identification of disease and more possible aggressive management. Moreover, gender-based strategy may benefit in HCM patients.

<b><i>背景：</i></b> 多种心脏疾病中已证实存在表型表达与临床结局的性别相关差异，但肥厚型心肌病（hypertrophic cardiomyopathy, HCM）中性别带来的影响仍不明确。本研究开展系统评价与荟萃分析，以评估男女肥厚型心肌病患者的临床结局差异。<b><i>方法：</i></b> 本研究检索了MEDLINE与EMBASE数据库自建库至2020年10月的文献。纳入标准为对比男女患者目标结局的队列研究，目标结局涵盖全因死亡率、肥厚型心肌病相关死亡率、心力衰竭（heart failure, HF）恶化及因心力衰竭住院事件。采用随机效应模型合并各项研究的原始数据，计算合并比值比（odds ratio, OR）与95%置信区间（confidence interval, CI）。<b><i>结果：</i></b> 最终纳入11项回顾性队列研究，累计纳入9427例患者（其中女性3719例）。女性性别与全因死亡率风险升高显著相关（合并比值比=1.63，95%置信区间：1.26~2.10，*p* ≤ 0.001），与肥厚型心肌病相关死亡率风险升高亦显著相关（合并比值比=1.47，95%置信区间：1.08~2.01，*p* = 0.015），同时与心力衰竭恶化或因心力衰竭住院的风险升高显著相关（合并比值比=2.05，95%置信区间：1.76~2.39，*p* ≤ 0.001）。<b><i>结论：</i></b> 女性性别与肥厚型心肌病患者更差的预后相关。本研究结果提示，需优化女性肥厚型心肌病患者的诊疗路径，包括早期疾病筛查与更积极的临床干预措施。此外，基于性别的个体化诊疗策略或可使肥厚型心肌病患者获益。