Sex- and age-based differences in the natural history and outcome of dilated cardiomyopathy.
Sex- and age-based differences in the natural history and outcome of dilated cardiomyopathy.
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基于性别和年龄的自然病史和扩张心肌病的结果。
DOI：
10.1002/ejhf.1216
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发表时间：
2018-10
影响因子：
18.2
通讯作者：
Prasad SK
中科院分区：
文献类型：
--
作者：
Halliday BP;Gulati A;Ali A;Newsome S;Lota A;Tayal U;Vassiliou VS;Arzanauskaite M;Izgi C;Krishnathasan K;Singhal A;Chiew K;Gregson J;Frenneaux MP;Cook SA;Pennell DJ;Collins P;Cleland JGF;Prasad SK
目的：探讨性别、年龄与扩张型心肌病（DCM）预后的关系。我们使用比例风险模型来检验连续DCM患者的性别、年龄和全因死亡率之间的关系。总的来说，881名患者（290名女性，中位年龄52岁）被随访了4.9年。与男性相比，女性更容易出现心力衰竭（64.0% vs. 54.5%; P = 0.007），并且症状更严重（P < 0.0001）。女性左室舒张末期容积较小（125 mL/m2 vs. 135 mL/m2; P < 0.001），左室射血分数较高（40.2% vs. 37.9%; P = 0.019），中壁晚期钆增强的可能性较小（23.0% vs. 38.9%; P < 0.0001）。随访期间，149例（16.9%）患者死亡，其中41例（4.7%）患者突然死亡。调整后，全因死亡率[危险比（HR） 0.61, 95%可信区间（CI） 0.41-0.92；在心血管疾病（HR 0.60, 95% CI 0.35-1.05; P = 0.07）、非猝死（HR 0.63, 95% CI 0.39-1.02; P = 0.06）和猝死（HR 0.70, 95% CI 0.30-1.63; P = 0.41）方面也有类似的趋势。全因死亡率（每10年：HR 1.36, 95% CI 1.20-1.55; P < 0.0001）和非猝死死亡率（每10年：HR 1.51, 95% CI 1.26-1.82; P < 0.00001）随着年龄的增长而增加。累积发病率曲线证实了有利的结果，特别是在妇女和<60岁的人群中。60岁以下患者的全因死亡率增加是由非猝死引起的。与男性相比，DCM女性的生存率更高，部分原因可能是左心室功能障碍较轻，疤痕负担较小。在60岁以下的患者中，非猝死导致的死亡率增加，但在女性中不太明显。当代治疗的结果是有利的，猝死发生率低。
To evaluate the relationship between sex, age and outcome in dilated cardiomyopathy (DCM). 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/m2 vs. 135 mL/m2; 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. 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.
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影响因子：
39.3
作者：
Shun-Shin MJ;Zheng SL;Cole GD;Howard JP;Whinnett ZI;Francis DP
通讯作者：
Francis DP
影响因子：
37.8
作者：
Elming, Marie Bayer;Nielsen, Jens C.;Thune, Jens Jakob
通讯作者：
Thune, Jens Jakob
影响因子：
5.7
作者：
Cocker, M. S.;Abdel-Aty, H.;Friedrich, M. G.
通讯作者：
Friedrich, M. G.
影响因子：
13
作者：
Loring, Zak;Canos, Daniel A.;Strauss, David G.
通讯作者：
Strauss, David G.
影响因子：
18.2
作者：
Martinez-Selles, Manuel;Doughty, Robert N.;Squire, Iain
通讯作者：
Squire, Iain