Imperial College London
Alternate

ProfessorStuartCook

Faculty of Medicine, Institute of Clinical Sciences

Visiting Professor
 
 
 
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Contact

 

+44 (0)20 3313 1346stuart.cook

 
 
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Location

 

RF 16Sydney StreetRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Owen:2024:10.1016/j.jchf.2023.10.009,
author = {Owen, R and Buchan, R and Frenneaux, M and Jarman, JWE and Baruah, R and Lota, AS and Halliday, BP and Roberts, AM and Izgi, C and Van, Spall H and Michos, ED and McMurray, J and Januzzi, JL and Pennell, DJ and Cook, SA and Ware, JS and Barton, PJ and Gregson, J and Prasad, SK and Tayal, U},
doi = {10.1016/j.jchf.2023.10.009},
journal = {JACC: Heart Failure},
pages = {352--363},
title = {Sex differences in the clinical presentation and natural history of dilated cardiomyopathy},
url = {http://dx.doi.org/10.1016/j.jchf.2023.10.009},
volume = {12},
year = {2024}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Biological sex has a diverse impact on the cardiovascular system. Its influence on dilated cardiomyopathy (DCM) remains unresolved.Objective: To investigate sex-specific differences in DCM presentation, natural history, and prognostic factors.Methods We conducted a prospective observational cohort study of DCM patients, assessing baseline characteristics, CMR-imaging, biomarkers and genotype. The composite outcome was cardiovascular mortality or major heart-failure (HF) events. Results: Overall, 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 (LVEF), smaller left ventricular volumes, less prevalent mid-wall myocardial fibrosis (23% vs 42%) and lower high sensitivity cardiac troponin (hs-cTnI) than males (all p<0.05), with no difference in time from diagnosis, age at enrollment, NT-proBNP levels, pathogenic DCM genetic variants, myocardial fibrosis extent or medications used for HF. Despite a more favourable profile, the risk of the primary outcome at 2 years was higher in females than males (8.6% vs 4.4%, adjusted hazard ratio 3.14, 95% CI 1.55 to 6.35, p=0.001).  Between 2-5 years, the effect of sex as a prognostic modifier attenuated. Age, mid-wall myocardial fibrosis, LVEF, left atrial volume, NT-proBNP, hs-cTnI, left bundle branch block and NYHA class were not sex specific prognostic factors. Conclusions: We identify 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.
AU  - Owen,R
AU  - Buchan,R
AU  - Frenneaux,M
AU  - Jarman,JWE
AU  - Baruah,R
AU  - Lota,AS
AU  - Halliday,BP
AU  - Roberts,AM
AU  - Izgi,C
AU  - Van,Spall H
AU  - Michos,ED
AU  - McMurray,J
AU  - Januzzi,JL
AU  - Pennell,DJ
AU  - Cook,SA
AU  - Ware,JS
AU  - Barton,PJ
AU  - Gregson,J
AU  - Prasad,SK
AU  - Tayal,U
DO  - 10.1016/j.jchf.2023.10.009
EP  - 363
PY  - 2024///
SN  - 2213-1787
SP  - 352
TI  - Sex differences in the clinical presentation and natural history of dilated cardiomyopathy
T2  - JACC: Heart Failure
UR  - http://dx.doi.org/10.1016/j.jchf.2023.10.009
UR  - https://www.jacc.org/doi/abs/10.1016/j.jchf.2023.10.009
UR  - http://hdl.handle.net/10044/1/107286
VL  - 12
ER  -
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