{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:46:21Z","timestamp":1791636381234,"version":"4.3.4"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"17","license":[{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Exercise performance is known to predict outcome in hypertrophic cardiomyopathy (HCM), but whether sex-related differences exist is unresolved. We explored whether functional impairment, assessed by exercise echocardiography, has comparable predictive accuracy in females and males with HCM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively evaluated 292 HCM patients (46\u2009\u00b1\u200916 years, 72% males), consecutively referred for exercise echocardiography; 242 were followed for 5.9\u2009\u00b1\u20094.2 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Peak exercise capacity was 6.5\u2009\u00b1\u20091.6 metabolic equivalents (METs). Sixty patients (21%) showed impaired exercise capacity (\u22645 METs). Exercise performance was reduced in females, compared with males (5.6\u2009\u00b1\u20091.6 vs 6.9\u2009\u00b1\u20091.5 METs, p\u2009&amp;lt;\u20090.001; peak METs\u2009\u2264\u20095 in 40% vs 13%, p\u2009&amp;lt;\u20090.001), largely driven by a worse performance in women &amp;gt;50 years of age. At multivariable analysis, female sex was independently associated with impaired exercise capacity (odds ratio: 4.67; 95% confidence interval (CI): 1.83\u201311.90; p\u2009=\u20090.001). During follow-up, 24 patients (10%) met the primary endpoint (a combination of cardiac death, heart failure requiring hospitalization, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator discharge, resuscitated sudden cardiac death and cardioembolic stroke). Event-free survival was reduced in females (p\u2009=\u20090.035 vs males). Peak METs were inversely related to outcome in males (hazard ratio (HR) per unit increase: 0.57; 95% CI: 0.39\u20130.84; p\u2009=\u20090.004) but not in females (HR: 1.22; 95% CI: 0.66\u20132.24; p\u2009=\u20090.53).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Female patients with HCM showed significant age-related impairment in functional capacity compared with males, particularly evident in post-menopausal age groups. While women were at greater risk of HCM-related complications and death, impaired exercise capacity predicted adverse outcome only in men. These findings suggest the need for sex-specific management strategies in HCM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1177\/2047487319886961","type":"journal-article","created":{"date-parts":[[2019,11,8]],"date-time":"2019-11-08T16:21:22Z","timestamp":1573230082000},"page":"1821-1831","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy"],"prefix":"10.1093","volume":"27","author":[{"given":"Luca","family":"Ghiselli","sequence":"first","affiliation":[{"name":"Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy"},{"name":"Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy"},{"name":"Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Marchi","sequence":"additional","affiliation":[{"name":"Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Fumagalli","sequence":"additional","affiliation":[{"name":"Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Maurizi","sequence":"additional","affiliation":[{"name":"Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Oddo","sequence":"additional","affiliation":[{"name":"Cardiology Department, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pieri","sequence":"additional","affiliation":[{"name":"Cardiology Department, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Girolami","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Meyer Children's Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Rowin","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Mazzarotto","sequence":"additional","affiliation":[{"name":"Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy"},{"name":"Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy"},{"name":"Cardiovascular Research Centre, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariantonietta","family":"Cicoira","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Ribichini","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Arretini","sequence":"additional","affiliation":[{"name":"Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Targetti","sequence":"additional","affiliation":[{"name":"Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Passantino","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Meyer Children's Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Cecchi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Marchionni","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Maron","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Mori","sequence":"additional","affiliation":[{"name":"Cardiology Department, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iacopo","family":"Olivotto","sequence":"additional","affiliation":[{"name":"Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,1]]},"reference":[{"key":"2021020116500138900_bibr1-2047487319886961","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jacc.2014.05.003","article-title":"Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine","volume":"64","author":"Maron","year":"2014","journal-title":"J Am Coll 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