TY - JOUR
T1 - Sex Differences in the Clinical Presentation and Natural History of Dilated Cardiomyopathy
AU - Owen, Ruth
AU - Buchan, Rachel
AU - Frenneaux, Michael
AU - Jarman, Julian W.E.
AU - Baruah, Resham
AU - Lota, Amrit S.
AU - Halliday, Brian P.
AU - Roberts, Angharad M.
AU - Izgi, Cemil
AU - Van Spall, Harriette G.C.
AU - Michos, Erin D.
AU - McMurray, John J.V.
AU - Januzzi, James L.
AU - Pennell, Dudley J.
AU - Cook, Stuart A.
AU - Ware, James S.
AU - Barton, Paul J.
AU - Gregson, John
AU - Prasad, Sanjay K.
AU - Tayal, Upasana
N1 - Publisher Copyright:
© 2024
PY - 2024/2
Y1 - 2024/2
N2 - Background: Biological sex has a diverse impact on the cardiovascular system. Its influence on dilated cardiomyopathy (DCM) remains unresolved. Objectives: This study aims to investigate sex-specific differences in DCM presentation, natural history, and prognostic factors. Methods: The authors conducted a prospective observational cohort study of DCM patients assessing baseline characteristics, cardiac magnetic resonance imaging, biomarkers, and genotype. The composite outcome was cardiovascular mortality or major heart failure (HF) events. Results: Overall, 206 females and 398 males with DCM were followed for a median of 3.9 years. At baseline, female patients had higher left ventricular ejection fraction, smaller left ventricular volumes, less prevalent mid-wall myocardial fibrosis (23% vs 42%), and lower high-sensitivity cardiac troponin I than males (all P < 0.05) with no difference in time from diagnosis, age at enrollment, N-terminal pro–B-type natriuretic peptide levels, pathogenic DCM genetic variants, myocardial fibrosis extent, or medications used for HF. Despite a more favorable profile, the risk of the primary outcome at 2 years was higher in females than males (8.6% vs 4.4%, adjusted HR: 3.14; 95% CI: 1.55-6.35; P = 0.001). Between 2 and 5 years, the effect of sex as a prognostic modifier attenuated. Age, mid-wall myocardial fibrosis, left ventricular ejection fraction, left atrial volume, N-terminal pro–B-type natriuretic peptide, high-sensitivity cardiac troponin I, left bundle branch block, and NYHA functional class were not sex-specific prognostic factors. Conclusions: The authors identified a novel paradox in prognosis for females with DCM. Female DCM patients have a paradoxical early increase in major HF events despite less prevalent myocardial fibrosis and a milder phenotype at presentation. Future studies should interrogate the mechanistic basis for these sex differences.
AB - Background: Biological sex has a diverse impact on the cardiovascular system. Its influence on dilated cardiomyopathy (DCM) remains unresolved. Objectives: This study aims to investigate sex-specific differences in DCM presentation, natural history, and prognostic factors. Methods: The authors conducted a prospective observational cohort study of DCM patients assessing baseline characteristics, cardiac magnetic resonance imaging, biomarkers, and genotype. The composite outcome was cardiovascular mortality or major heart failure (HF) events. Results: Overall, 206 females and 398 males with DCM were followed for a median of 3.9 years. At baseline, female patients had higher left ventricular ejection fraction, smaller left ventricular volumes, less prevalent mid-wall myocardial fibrosis (23% vs 42%), and lower high-sensitivity cardiac troponin I than males (all P < 0.05) with no difference in time from diagnosis, age at enrollment, N-terminal pro–B-type natriuretic peptide levels, pathogenic DCM genetic variants, myocardial fibrosis extent, or medications used for HF. Despite a more favorable profile, the risk of the primary outcome at 2 years was higher in females than males (8.6% vs 4.4%, adjusted HR: 3.14; 95% CI: 1.55-6.35; P = 0.001). Between 2 and 5 years, the effect of sex as a prognostic modifier attenuated. Age, mid-wall myocardial fibrosis, left ventricular ejection fraction, left atrial volume, N-terminal pro–B-type natriuretic peptide, high-sensitivity cardiac troponin I, left bundle branch block, and NYHA functional class were not sex-specific prognostic factors. Conclusions: The authors identified a novel paradox in prognosis for females with DCM. Female DCM patients have a paradoxical early increase in major HF events despite less prevalent myocardial fibrosis and a milder phenotype at presentation. Future studies should interrogate the mechanistic basis for these sex differences.
KW - females
KW - heart
KW - males
KW - sex
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U2 - 10.1016/j.jchf.2023.10.009
DO - 10.1016/j.jchf.2023.10.009
M3 - Article
C2 - 38032570
AN - SCOPUS:85180786267
SN - 2213-1779
VL - 12
SP - 352
EP - 363
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 2
ER -