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Canadian Journal of Cardiology

Sex Differences in the Long-term Prognosis of Dilated Cardiomyopathy

      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.
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      Linked Article

      • Battle of the Sexes: Differential Prognosis by Sex in Dilated Cardiomyopathy
        Canadian Journal of CardiologyVol. 36Issue 1
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          The 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.
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