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. 2018 Oct;20(10):1392-1400.
doi: 10.1002/ejhf.1216. Epub 2018 Jun 3.

Sex- and age-based differences in the natural history and outcome of dilated cardiomyopathy

Brian P Halliday  1   2 , Ankur Gulati  1 , Aamir Ali  1   2 , Simon Newsome  3 , Amrit Lota  1   2 , Upasana Tayal  1   2 , Vassilios S Vassiliou  1   4 , Monika Arzanauskaite  1 , Cemil Izgi  1 , Kaushiga Krishnathasan  1 , Arvind Singhal  1 , Kayla Chiew  2 , John Gregson  3 , Michael P Frenneaux  4 , Stuart A Cook  1   2   5 , Dudley J Pennell  1   2 , Peter Collins  1   2 , John G F Cleland  1   2   6 , Sanjay K Prasad  1   2
Affiliations

Sex- and age-based differences in the natural history and outcome of dilated cardiomyopathy

Brian P Halliday et al. Eur J Heart Fail. 2018 Oct.

Abstract

Aim: To evaluate the relationship between sex, age and outcome in dilated cardiomyopathy (DCM).

Methods and results: 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.

Conclusion: 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.

Keywords: Age; Dilated cardiomyopathy; Outcome; Sex.

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Figures

Figure 1
Figure 1
Identification, inclusion and exclusion of patients from the study cohort. CAD, coronary artery disease; CMR, cardiovascular magnetic resonance; LGE, late gadolinium enhancement; LVEDV, left ventricular end‐diastolic volume; LVEF, left ventricular ejection fraction.
Figure 2
Figure 2
Forest plots demonstrating unadjusted and adjusted hazard ratios for the primary and secondary endpoints stratified by sex and age. CV, cardiovascular; SCD, sudden cardiac death.
Figure 3
Figure 3
Cumulative incidence curves demonstrating the occurrence of endpoints based on the age and sex of patients. CV, cardiovascular.
See this image and copyright information in PMC

Comment in

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