Abstract
Background
Dilated cardiomyopathy (DCM) represents a specific phenotype of heart failure. Sex
differences in the long-term prognosis of patients with DCM are unknown. The aim of
this study is to investigate the long-term prognostic role of gender in a large cohort
of patients with DCM.
Methods
A total of 1113 patients with DCM were prospectively enrolled. To investigate the
impact of sex, a propensity score–matching analysis was performed on a sample of 586
patients. Univariable and multivariable Cox models and competing-risk analyses were
estimated on both cohorts for the following outcome measures: (1) all-cause mortality/heart
transplantation (HTx)/ventricular assist device (VAD); (2) cardiovascular mortality/HTx/VAD;
and (3) sudden cardiac death or malignant ventricular arrhythmias.
Results
Women were older than men (50 ± 15 years vs 47 ± 15 years, respectively, P = 0.004) and more frequently had moderate to severe left ventricular dilation (P < 0.001) and left bundle branch block (P = 0.019). At multivariable analyses, male sex was independently associated with all
considered outcome measures in the total cohort. At propensity score–matching analysis,
over a median follow-up of 126 months (interquartile range, 62-201), 96 men (33%)
vs 66 women (22%) experienced all-cause mortality/HTx/VAD (P = 0.03), 95 men (32%) vs 57 women (20%) experienced cardiovascular mortality/HTx/VAD
(P = 0.025), and 46 men (16%) vs 28 women (10%) experienced sudden cardiac death/malignant
ventricular arrhythmias (P = 0.07).
Conclusion
The long-term outcomes of women affected by DCM are more favourable than those of
men, and sex emerged as an important independent factor, particularly for cardiovascular
outcomes.
Résumé
Contexte
La cardiomyopathie dilatée représente un phénotype précis d’insuffisance cardiaque.
Les différences en fonction du sexe quant au pronostic à long terme des patients atteints
de cette affection sont inconnues. Cette étude vise à évaluer l’incidence du sexe
dans le pronostic à long terme de la cardiomyopathie dilatée chez une vaste cohorte
de patients qui en sont atteints.
Méthodologie
Au total, 1113 patients atteints de cardiomyopathie dilatée ont été inscrits à l’étude
de manière prospective. Pour évaluer l’incidence du sexe, un échantillon de 586 patients
a fait l’objet d’une analyse d’appariement des coefficients de propension. Des modèles
de Cox à une seule et à plusieurs variables ainsi que des analyses des risques concurrentiels
ont été utilisés pour évaluer les paramètres suivants dans les deux cohortes : (1)
décès toutes causes confondues, transplantation cardiaque (TC) et recours à un dispositif
d’assistance ventriculaire (DAV); (2) décès d’origine cardiovasculaire, TC et recours
à un DAV et (3) mort subite d’origine cardiaque et arythmies ventriculaires malignes.
Résultats
Les femmes étaient plus âgées que les hommes (50 ± 15 ans contre 47 ± 15 ans, p = 0,004) et présentaient plus fréquemment une dilatation du ventricule gauche modérée
ou grave (p < 0,001) et un bloc de branche gauche (p = 0,019). Les analyses multivariables ont révélé que le sexe masculin était indépendamment
associé à tous les paramètres évalués dans l’ensemble de la cohorte. Dans l’analyse
d’appariement des coefficients de propension, au cours d’un suivi médian de 126 mois
(écart interquartile de 62 à 201), 96 hommes (33 %) comparativement à 66 femmes (22
%) ont atteint les critères d’évaluation composés du décès toutes causes confondues,
de la TC et du recours à un DAV (p = 0,03), 95 hommes (32 %) comparativement à 57 femmes (20 %), les critères d’évaluation
composés du décès d’origine cardiovasculaire, de la TC et du recours à un DAV (p = 0,025), et 46 hommes (16 %) comparativement à 28 femmes (10 %), les critères d’évaluation
composés de la mort subite d’origine cardiaque et des arythmies ventriculaires malignes
(p = 0,07).
Conclusion
L’issue à long terme de la cardiomyopathie dilatée est plus favorable chez les femmes
que chez les hommes et le sexe ressort comme un important facteur indépendant, particulièrement
en ce qui a trait aux issues cardiovasculaires.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes.Circulation. 2011; 124: 2145-2154
- Pathways for salvage and protection of the heart under stress: novel routes for cardiac rejuvenation.Cardiovasc Res. 2016; 111: 142-153
- Long-term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: changing mortality over the last 30 years.Eur J Heart Fail. 2014; 16: 317-324
- Evolving concepts in dilated cardiomyopathy.Eur J Heart Fail. 2018; 20: 228-239
- Temporal trends of women enrollment in major cardiovascular randomized clinical trials.Can J Cardiol. 2019; 35: 653-660
- Prevalence and prognostic significance of left ventricular reverse remodeling in dilated cardiomyopathy receiving tailored medical treatment.J Am Coll Cardiol. 2011; 57: 1468-1476
- Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study.J Am Coll Cardiol. 2011; 58: 1112-1118
- Sex-specific considerations in guidelines generation and application.Can J Cardiol. 2019; 35: 598-605
- Comparison of clinical findings in idiopathic dilated cardiomyopathy in women versus men. The Italian Multicenter Cardiomyopathy Study Group (SPIC).Am J Cardiol. 1993; 72: 580-585
- Sex- and age-based differences in the natural history and outcome of dilated cardiomyopathy.Eur J Heart Fail. 2018; 20: 1392-1400
- Conflicting gender-related differences in the natural history of patients with idiopathic dilated cardiomyopathy.Epidemiol Biostat Public Health. 2017; 14 (e1527-21-e1527-8)
- Proposal for a revised definition of dilated cardiomyopathy, hypokinetic nondilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases.Eur Heart J. 2016; 37: 1850-1858
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.Eur Heart J. 2016; 37: 2129-2200
- 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).Eur Heart J. 2013; 34: 2281-2329
- Arrhythmogenic phenotype in dilated cardiomyopathy: natural history and predictors of life-threatening arrhythmias.J Am Heart Assoc. 2015; 4e002149
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39 e14
- Investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) Registry. Sex differences in left ventricular cavity dilation and outcomes in acute heart failure patients with left ventricular systolic dysfunction.Can J Cardiol. 2018; 34: 477-484
- Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance.J Am Soc Echocardiogr. 2017; 30: 303-371
- A class of K-sample tests for comparing the cumulative incidence of a competing risk.Ann Stat. 1988; 16: 1141-1154
- Multivariate and propensity score matching software with automated balance optimization: the matching package for R.J Stat Softw. 2011; 42: 52
- Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.Stat Med. 2015; 34: 3661-3679
- Proportional hazards tests and diagnostics based on weighted residuals.Biometrika. 1994; 81: 515-526
- Arrhythmic risk stratification in patients with idiopathic dilated cardiomyopathy.Am J Cardiol. 2018; 121: 1601-1609
- Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women’s Heart Alliance.J Am Coll Cardiol. 2017; 70: 123-132
- Left bundle branch block predicts better survival in women than men receiving cardiac resynchronization therapy: long-term follow-up of approximately 145,000 patients.JACC Heart Fail. 2013; 1: 237-244
- Sex and gender differences in myocarditis and dilated cardiomyopathy.Curr Probl Cardiol. 2013; 38: 7-46
- Sex- and age-dependent human transcriptome variability: implications for chronic heart failure.Proc Natl Acad Sci U S A. 2003; 100: 2754-2759
- Genome-wide histone methylation profile for heart failure.Genes Cells. 2009; 14: 69-77
- How cardiomyocyte excitation, calcium release and contraction become altered with age.J Mol Cell Cardiol. 2015; 83: 62-72
- Hormone replacement therapy and cardioprotection: what is good and what is bad for the cardiovascular system?.Ann N Y Acad Sci. 2006; 1092: 341-348
- Sex differences in cardiomyopathies.Eur J Heart Fail. 2014; 16: 238-247
- Heart failure in women: a need for prospective data.J Am Coll Cardiol. 2009; 54: 491-498
- Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology.Eur Heart J. 2006; 27: 994-1005
Article info
Publication history
Published online: May 30, 2019
Accepted:
May 24,
2019
Received:
April 16,
2019
Footnotes
See editorial by Yogasundaram et al., pages 7–10of this issue.
See page 43 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Battle of the Sexes: Differential Prognosis by Sex in Dilated CardiomyopathyCanadian Journal of CardiologyVol. 36Issue 1
- PreviewThe role of sex differences in cardiovascular disease (CVD) has received considerable attention in recent years. These differences not only include diseases and risk factors unique to one sex, such as pregnancy-related cardiovascular changes in women, but also to common diseases and risk factors that differentially affect members of one sex. Epidemiological research confirms sex differences in the prevalence of risk factors—such as hypertension, diabetes mellitus, obesity, dyslipidemia, and smoking—between men and women.
- Full-Text
- Preview
