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- Title
Sex-based differences in the phenotypic expression and prognosis of idiopathic non-ischaemic cardiomyopathy: a cardiovascular magnetic resonance study.
- Authors
Mallabone, Maggie; Labib, Dina; Abdelhaleem, Ahmed; Dykstra, Steven; Thompson, Richard B; Paterson, D Ian; Thompson, Sam K; Hasanzadeh, Fereshteh; Mikami, Yoko; Rivest, Sandra; Flewitt, Jacqueline; Feng, Yuanchao; Macdonald, Matthew; King, Melanie; Bristow, Michael; Kolman, Louis; Howarth, Andrew G; Lydell, Carmen P; Miller, Robert J H; Fine, Nowell M
- Abstract
Aims We sought to characterize sex-related differences in cardiovascular magnetic resonance-based cardiovascular phenotypes and prognosis in patients with idiopathic non-ischaemic cardiomyopathy (NICM). Methods and results Patients with NICM enrolled in the Cardiovascular Imaging Registry of Calgary (CIROC) between 2015 and 2021 were identified. Z -score values for chamber volumes and function were calculated as standard deviation from mean values of 157 sex-matched healthy volunteers, ensuring reported differences were independent of known sex-dependencies. Patients were followed for the composite outcome of all-cause mortality, heart failure admission, or ventricular arrhythmia. A total of 747 patients were studied, 531 (71%) males. By Z -score values, females showed significantly higher left ventricular (LV) ejection fraction (EF; median difference 1 SD) and right ventricular (RV) EF (difference 0.6 SD) with greater LV mass (difference 2.1 SD; P < 0.01 for all) vs. males despite similar chamber volumes. Females had a significantly lower prevalence of mid-wall striae (MWS) fibrosis (22% vs. 34%; P < 0.001). Over a median follow-up of 4.7 years, 173 patients (23%) developed the composite outcome, with equal distribution in males and females. LV EF and MWS were significant independent predictors of the outcome (respective HR [95% CI] 0.97 [0.95–0.99] and 1.6 [1.2–2.3]; P = 0.003 and 0.005). There was no association of sex with the outcome. Conclusion In a large contemporary cohort, NICM was uniquely expressed in females vs. males. Despite similar chamber dilation, females demonstrated greater concentric remodelling, lower reductions in bi-ventricular function, and a lower burden of replacement fibrosis. Overall, their prognosis remained similar to male patients with NICM.
- Subjects
LEFT heart ventricle; CARDIOMYOPATHIES; RESEARCH funding; PATIENTS; VENTRICULAR ejection fraction; MYOCARDIAL ischemia; LEFT heart atrium; SEX distribution; HOSPITAL admission &; discharge; DESCRIPTIVE statistics; CAUSES of death; HEART failure; FIBROSIS; CARDIOVASCULAR disease diagnosis; MAGNETIC resonance angiography; VENTRICULAR arrhythmia; RIGHT heart atrium; CORONARY angiography; RIGHT heart ventricle; CONFIDENCE intervals; STROKE volume (Cardiac output); PHENOTYPES
- Publication
European Heart Journal - Cardiovascular Imaging, 2024, Vol 25, Issue 6, p804
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jeae014