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

Halliday, B. P. et al. (2018) Sex and age-based differences in the natural history and outcome of dilated cardiomyopathy. European Journal of Heart Failure, 20(10), pp. 1392-1400. (doi: 10.1002/ejhf.1216) (PMID:29862606) (PMCID:PMC6392171)

Abstract

Aims: To evaluate the relationship between sex, age and outcome in dilated cardiomyopathy (DCM). Methods & 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<0.001) compared to men. Women had smaller left ventricular end-diastolic volume (125ml/m2 vs 135ml/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 (HR 0.61; 95%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 yrs: HR 1.36, 95%CI 1.20 1.55; p<0.00001) and non-sudden death (per 10 yrs: 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.

• Item Type: Articles
• Additional Information: BPH is supported by a British Heart Foundation Clinical Research Training Fellowship (FS/15/29/31492). VSV has received grant support from Rosetrees Charity Trust. JGFC has received non-financial research support from Boston Scientific and Medtronic. DJP has received research support from Siemens and is a stockholder and director of CVIS. SKP has received grant support from BHF, the Alexander Jansons Foundation and the Rosetrees Charity Trust.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Halliday, B. P., Gulati, A., Ali, A., Newsome, S., Lota, A., Tayal, U., Vassiliou, V. S., Arzanauskaite, M., Izgi, C., Krishnathasan, K., Singhal, A., Chiew, K., Gregson, J., Frenneaux, M. P., Cook, S. A., Pennell, D. J., Collins, P., Cleland, J. G.F., and Prasad, S. K.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 03 June 2018
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in European Journal of Heart Failure 20(10): 1392-1400
• Publisher Policy: Reproduced under a Creative Commons License