Sex- and age-based differences in the natural history and outcome of dilated cardiomyopathy.

Autor: Halliday BP; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; National Heart & Lung Institute, Imperial College, London, UK., Gulati A; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK., Ali A; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; National Heart & Lung Institute, Imperial College, London, UK., Newsome S; London School of Hygiene and Tropical Medicine, London, UK., Lota A; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; National Heart & Lung Institute, Imperial College, London, UK., Tayal U; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; National Heart & Lung Institute, Imperial College, London, UK., Vassiliou VS; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; Norwich Medical School, University of East Anglia, Norwich, UK., Arzanauskaite M; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK., Izgi C; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK., Krishnathasan K; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK., Singhal A; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK., Chiew K; National Heart & Lung Institute, Imperial College, London, UK., Gregson J; London School of Hygiene and Tropical Medicine, London, UK., Frenneaux MP; Norwich Medical School, University of East Anglia, Norwich, UK., Cook SA; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; National Heart & Lung Institute, Imperial College, London, UK.; National Heart Centre Singapore, Singapore., Pennell DJ; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; National Heart & Lung Institute, Imperial College, London, UK., Collins P; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; National Heart & Lung Institute, Imperial College, London, UK., Cleland JGF; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; National Heart & Lung Institute, Imperial College, London, UK.; Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK., Prasad SK; Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.; National Heart & Lung Institute, Imperial College, London, UK.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2018 Oct; Vol. 20 (10), pp. 1392-1400. Date of Electronic Publication: 2018 Jun 03.
DOI: 10.1002/ejhf.1216
Abstrakt: Aim: To evaluate the relationship between sex, age and outcome in dilated cardiomyopathy (DCM).
Methods and Results: We used proportional hazard modelling to examine the association between sex, age and all-cause mortality in consecutive patients with DCM. Overall, 881 patients (290 women, median age 52 years) were followed for a median of 4.9 years. Women were more likely to present with heart failure (64.0% vs. 54.5%; P = 0.007) and had more severe symptoms (P < 0.0001) compared to men. Women had smaller left ventricular end-diastolic volume (125 mL/m 2 vs. 135 mL/m 2 ; P < 0.001), higher left ventricular ejection fraction (40.2% vs. 37.9%; P = 0.019) and were less likely to have mid-wall late gadolinium enhancement (23.0% vs. 38.9%; P < 0.0001). During follow-up, 149 (16.9%) patients died, including 41 (4.7%) who died suddenly. After adjustment, all-cause mortality [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.41-0.92; P = 0.018] was lower in women, with similar trends for cardiovascular (HR 0.60, 95% CI 0.35-1.05; P = 0.07), non-sudden (HR 0.63, 95% CI 0.39-1.02; P = 0.06) and sudden death (HR 0.70, 95% CI 0.30-1.63; P = 0.41). All-cause mortality (per 10 years: HR 1.36, 95% CI 1.20-1.55; P < 0.0001) and non-sudden death (per 10 years: HR 1.51, 95% CI 1.26-1.82; P < 0.00001) increased with age. Cumulative incidence curves confirmed favourable outcomes, particularly in women and those <60 years. Increased all-cause mortality in patients >60 years of age was driven by non-sudden death.
Conclusion: Women with DCM have better survival compared to men, which may partly be due to less severe left ventricular dysfunction and a smaller scar burden. There is increased mortality driven by non-sudden death in patients >60 years of age that is less marked in women. Outcomes with contemporary treatment were favourable, with a low incidence of sudden death.
(© 2018 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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