Sex Differences in the Clinical Presentation and Natural History of Dilated Cardiomyopathy.

Autor:	Owen R; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom., Buchan R; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Frenneaux M; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Jarman JWE; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Baruah R; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Lota AS; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Halliday BP; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Roberts AM; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Izgi C; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Van Spall HGC; Department of Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Cardiology Division, Massachusetts General Hospital, Baim Institute for Clinical Research, Boston, Massachusetts, USA., Michos ED; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., McMurray JJV; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom., Januzzi JL; Cardiology Division, Massachusetts General Hospital, Baim Institute for Clinical Research, Boston, Massachusetts, USA., Pennell DJ; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Cook SA; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Ware JS; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; MRC London Institute of Medical Sciences, London, United Kingdom., Barton PJ; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Gregson J; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom., Prasad SK; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom., Tayal U; National Heart Lung Institute, Imperial College London, United Kingdom; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: u.tayal@rbht.nhs.uk.
Jazyk:	angličtina
Zdroj:	JACC. Heart failure [JACC Heart Fail] 2024 Feb; Vol. 12 (2), pp. 352-363. Date of Electronic Publication: 2023 Nov 29.
DOI:	10.1016/j.jchf.2023.10.009
Abstrakt:	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. Competing Interests: Funding Support and Author Disclosures This work was supported by the UK Medical Research Council (MR/W023830/1), the National Heart Lung Institute Research Foundation, Royston Centre for Cardiomyopathy Research, NIHR Biomedical Research Unit Royal Brompton Hospital, NIHR Imperial College Biomedical Research Centre, British Heart Foundation (RE/18/4/34215; SP/10/10/28431; SP/17/11/32885; BH FS/ICRF/21/26019), Wellcome Trust (107469/Z/15/Z), Rosetrees Trust, Sir Jules Thorn Charitable Trust [21JTA], and Alexander Jansons Myocarditis UK. Dr Januzzi has been supported in part by the Hutter Family Professorship. Dr Van Spall has been funded by the Canadian Institutes of Health Research and Heart and Stroke Foundation of Canada. Dr Michos has participated in advisory boards for Novo Nordisk, Novartis, Bayer, Esperion, AstraZeneca, and Amarin. Dr Januzzi has been a trustee of the American College of Cardiology; has been a board member of Imbria Pharmaceuticals; has been a director at Jana Care; has received grant support from Abbott Diagnostics, Applied Therapeutics, HeartFlow, Innolife, and LivaNova; has received consulting fees from Abbott, Bayer, Beckman-Coulter, Boehringer-Ingelheim, Janssen, Novartis, Quidel, Roche Diagnostics, and Siemens; and has participated in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Bayer, CVRx, Intercept, Pfizer, and Takeda. Dr Pennell has received consulting fees from Bayer and Chiesi; has received research support from Bayer and Siemens; and has received speaker fees from Chiesi and Bayer. Dr Cook has been a co-founder and shareholder with Enleofen Bio PTE LTD. Dr Ware has received consulting fees from MyoKardia and Foresite Labs; and has received research support from MyoKardia/Bristol Myers Squibb. Dr Halliday has participated in an advisory board with AstraZeneca. Dr Baruah is working full-time for AstraZeneca. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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