• Cardiomyopathy, Hypertrophic

Hypertrophic obstructive cardiomyopathy (HOCM) is currently treated with septal reduction therapy in severely symptomatic patients who are not responsive to medical treatment. Since its introduction by Dr Ulrich Sigwart in 1995, alcohol septal ablation (ASA) has been increasingly performed across the globe. In fact, after discussion of risks, benefits and alternatives, many patients elect to undergo ASA.

There have been several attempts to identify ASA outcome predictors in this patient population and there are concerns about worse outcomes in female patients. This important question is tackled in this issue of the journal by Lawin et al.1 The authors report on procedural outcomes at 1–4 days and at 6 months after ASA in 1367 patients with HOCM, stratified by sex. In comparison with men, women were older but had similar prevalence of coronary artery disease. Overall, symptomatic status was worse in women with more frequent syncope, and more severe dyspnoea and angina. Despite these differences, there were no apparent differences in medical therapy prior to ASA. Symptoms were corroborated by a significantly shorter 6-minute walking distance (6MWD) in women prior to ASA. However, we are not told whether there was a difference in the doses of the drugs used or the combination of medications (eg, beta-blockers and disopyramide). Importantly, both resting gradients and exercise-induced gradients (supine bicycle exercise to workload of 75 W for 5 min) were similar between men and …