1. Sex-based differences in the phenotypic expression and prognosis of idiopathic non-ischaemic cardiomyopathy: a cardiovascular magnetic resonance study.
- Author
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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, and Fine, Nowell M
- 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 - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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