Sex-Specific Prognostic Implications in Dilated Cardiomyopathy After Left Ventricular Reverse Remodeling

Journal of Clinical Medicine - Tập 9 Số 8 - Trang 2426
Antonio Cannatà1,2, Paolo Manca1, Vincenzo Nuzzi1, Caterina Gregorio3, Jessica Artico1, Piero Gentile1, Carola Pio Loco1, Federica Ramani1, Giulia Barbati3, Marco Merlo1, Gianfranco Sinagra1
1Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste, 34100 Trieste, Italy
2Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE5 9NU, UK
3Biostatistics Unit, University of Trieste, 34100 Trieste, Italy

Tóm tắt

Background. Women affected by Dilated Cardiomyopathy (DCM) experience better outcomes compared to men. Whether a more pronounced Left Ventricular Reverse Remodelling (LVRR) might explain this is still unknown. Aim. We investigated the relationship between LVRR and sex and its long-term outcomes. Methods. A cohort of 605 DCM patients with available follow-up data was consecutively enrolled. LVRR was defined, at 24-month follow-up evaluation, as an increase in left ventricular ejection fraction (LVEF) ≥ 10% or a LVEF > 50% and a decrease ≥ 10% in indexed left ventricular end-diastolic diameter (LVEDDi) or an LVEDDi ≤ 33 mm/m2. Outcome measures were a composite of all-cause mortality/heart transplantation (HTx) or ventricular assist device (VAD) and a composite of Sudden Cardiac Death (SCD) or Major Ventricular Arrhythmias (MVA). Results. 181 patients (30%) experienced LVRR. The cumulative incidence of LVRR at 24-months evaluation was comparable between sexes (33% vs. 29%; p = 0.26). During a median follow-up of 149 months, women experiencing LVRR had the lowest rate of main outcome measure (global p = 0.03) with a 71% relative risk reduction compared to men with LVRR, without significant difference between women without LVRR and males. A trend towards the same results was found regarding SCD/MVA (global p = 0.06). Applying a multi-state model, male sex emerged as an independent adverse prognostic factor even after LVRR completion. Conclusions. Although the rate of LVRR was comparable between sexes, females experiencing LVRR showed the best outcomes in the long term follow up compared to males and females without LVRR. Further studies are advocated to explain this difference in outcomes between sexes.

Từ khóa


Tài liệu tham khảo

Merlo, 2017, Evolving concepts in dilated cardiomyopathy, Eur. J. Heart Fail., 20, 228, 10.1002/ejhf.1103

Merlo, 2014, Long-term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: Changing mortality over the last 30 years, Eur. J. Heart Fail., 16, 317, 10.1002/ejhf.16

Merlo, 2016, Clinical management of dilated cardiomyopathy: Current knowledge and future perspectives, Expert Rev. Cardiovasc. Ther., 14, 137, 10.1586/14779072.2016.1125292

Tayal, U., Wage, R., Newsome, S., Manivarmane, R., Izgi, C., Muthumala, A., Dungu, J.N., Assomull, R., Hatipoglu, S., and Halliday, B.P. (2020). Predictors of left ventricular remodelling in patients with dilated cardiomyopathy–a cardiovascular magnetic resonance study. Eur. J. Heart Fail.

Merlo, 2011, Prevalence and prognostic significance of left ventricular reverse remodeling in dilated cardiomyopathy receiving tailored medical treatment, J. Am. Coll. Cardiol., 57, 1468, 10.1016/j.jacc.2010.11.030

Fabris, 2019, Sex differences in the long-term prognosis of dilated cardiomyopathy, Can. J. Cardiol., 36, 37

Halliday, 2018, Sex- and age-based differences in the natural history and outcome of dilated cardiomyopathy, Eur. J. Heart Fail., 20, 1392, 10.1002/ejhf.1216

Fabris, 2020, Gender-related differences in heart failure: Beyond the “one-size-fits-all” paradigm, Heart Fail. Rev., 25, 245, 10.1007/s10741-019-09824-y

Ponikowski, 2016, 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., 37, 2129, 10.1093/eurheartj/ehw128

Brignole, 2013, 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., 34, 2281, 10.1093/eurheartj/eht150

Lang, 2015, 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., 28, 1, 10.1016/j.echo.2014.10.003

Kajimoto, 2020, Investigators of the acute decompensated heart failure syndromes, r. sex differences in New York heart association functional classification and survival in acute heart failure patients with preserved or reduced ejection fraction, Can. J. Cardiol., 36, 30, 10.1016/j.cjca.2019.08.020

Kajimoto, 2018, Sex differences in left ventricular cavity dilation and outcomes in acute heart failure patients with left ventricular systolic dysfunction, Can. J. Cardiol., 34, 477, 10.1016/j.cjca.2018.01.019

Gray, 1988, A class of k-sample tests for comparing the cumulative incidence of a competing risk, Ann. Statist., 16, 1141, 10.1214/aos/1176350951

Therneau, 1994, Proportional hazards tests and diagnostics based on weighted residuals, Biometrika, 81, 515, 10.1093/biomet/81.3.515

Meyer, 2014, Sex differences in cardiomyopathies, Eur. J. Heart Fail., 16, 238, 10.1002/ejhf.15

Mosca, 2011, Sex/gender differences in cardiovascular disease prevention: What a difference a decade makes, Circulation, 124, 2145, 10.1161/CIRCULATIONAHA.110.968792

Lam, 2019, Sex differences in heart failure, Eur. Heart J., 40, 3859, 10.1093/eurheartj/ehz835

Lainscak, 2020, Sex and age related differences in the management and outcomes of chronic heart failure: An analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry, Eur. J. Heart Fail., 22, 92, 10.1002/ejhf.1645

Boheler, 2003, Sex- and age-dependent human transcriptome variability: Implications for chronic heart failure, Proc. Natl. Acad. Sci. USA, 100, 2754, 10.1073/pnas.0436564100

Kaneda, 2009, Genome-wide histone methylation profile for heart failure, Genes Cells, 14, 69, 10.1111/j.1365-2443.2008.01252.x

Feridooni, 2015, How cardiomyocyte excitation, calcium release and contraction become altered with age, J. Mol. Cell Cardiol., 83, 62, 10.1016/j.yjmcc.2014.12.004

Cannata, 2016, Pathways for salvage and protection of the heart under stress: Novel routes for cardiac rejuvenation, Cardiovasc. Res., 111, 142, 10.1093/cvr/cvw106

Thông tin
Thông tin xuất bản

Journal of Clinical Medicine

Tập 9 Số 8

2426

Thông tin tác giả