Sex Differences in the Clinical Presentation and Natural History of Dilated Cardiomyopathy.
Sex Differences in the Clinical Presentation and Natural History of Dilated Cardiomyopathy.
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扩张型心肌病临床表现和自然史的性别差异。
DOI：
10.1016/j.jchf.2023.10.009
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Owen R
中科院分区：
文献类型：
--
作者：
Owen R
研究背景生物性别对心血管系统有多种影响。其对扩张型心肌病（DCM）的影响仍未解决。ObjectivesThis study aims to investigate sex-specific differences in DCM presentation，natural history，and prognostic factors.MethodsThe authors carried out a prospective observational cohort study of DCM patients assessing baseline characteristics，cardiac magnetic resonance imaging，biomarker，and genotype.复合结果是心血管死亡率或主要的心脏衰竭（HF）events.ResultsOverall，206名女性和398名男性DCM随访中位数为3.9年。基线时，女性患者左室射血分数较高，左室容积较小，中壁心肌纤维化较轻（23% vs 42%），高敏感性心肌肌钙蛋白I低于男性（均P < 0.05），在诊断时间、入组年龄、N末端B型利钠肽前体水平、致病性DCM遗传变异、心肌纤维化程度、或用于HF的药物。尽管女性的情况更有利，但2年时主要结局的风险高于男性（8.6% vs 4.4%，校正HR：3.14; 95% CI：1.55-6.35;P= 0.001）。在2到5年之间，性别作为预后调节因子的作用减弱。年龄，中壁心肌纤维化，左心室射血分数，左心房容积，N-末端前B型利钠肽，高敏心肌肌钙蛋白I，左束分支阻滞，NYHA心功能分级不是性别特异性的预后factors.ConclusionsThe作者确定了一个新的矛盾，在女性DCM的预后。女性扩张型心肌病患者尽管心肌纤维化发生率较低且表现出较轻的表型，但其主要心力衰竭事件的早期发生率却反常地增加。未来的研究应该探究这些性别差异的机制基础。
BackgroundBiological sex has a diverse impact on the cardiovascular system. Its influence on dilated cardiomyopathy (DCM) remains unresolved.ObjectivesThis study aims to investigate sex-specific differences in DCM presentation, natural history, and prognostic factors.MethodsThe 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.ResultsOverall, 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 (allP< 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.ConclusionsThe 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.