Sex Differences in the Long-term Prognosis of Dilated Cardiomyopathy

Cannatà, Antonio; Fabris, Enrico; Merlo, Marco; Artico, Jessica; Gentile, Piero; Loco, Carola Pio; Ballaben, Andrea; Ramani, Federica; Barbati, Giulia; Sinagra, Gianfranco

doi:10.1016/j.cjca.2019.05.031

Cited by 51 publications

(54 citation statements)

References 31 publications

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“…In contrast to the most recent discoveries of Cannata et al with regard to a lower mortality rate in women, in our own analysis, gender was not found to be related to the outcome in multivariate prognostic analyses, a finding which is in accordance with the BCN Bio-HF and SHFM studies. [33][34][35] Intriguingly, EF was not found to be a significant independent prognostic factor, which is in line with the BCN Bio-HF study, but not with the latest prognostic analysis in HF, that is, PARADIGM-HF (Simpson et al reported a 7% decrease in mortality rate for every 5% increase of EF). 36 Similarly, BB usage was not a crucial factor (probably due to the high rate of use of this treatment in both survivors and non-survivors).…”

Section: The Development Of a Mortality Calculator Tailored For Dilatsupporting

confidence: 60%

Mortality risk in dilated cardiomyopathy: the accuracy of heart failure prognostic models and dilated cardiomyopathy‐tailored prognostic model

et al. 2020

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Aims The aims of this paper were to investigate the analytical performance of the nine prognostic scales commonly used in heart failure (HF), in patients with dilated cardiomyopathy (DCM), and to develop a unique prognostic model tailored to DCM patients. Methods and results The hospital and outpatient records of 406 DCM patients were retrospectively analysed. The information on patient status was gathered after 48.2 ± 32.0 months. Tests were carried out to ascertain the prognostic accuracy in DCM using some of the most frequently applied HF prognostic scales (Barcelona Bio-Heart Failure, Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity, Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure, Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure, Meta-Analysis Global Group in Chronic Heart Failure, MUerte Subita en Insuficiencia Cardiaca, Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure, Seattle Heart Failure Model) and one dedicated to DCM, that of Miura et al. At follow-up, 70 DCM patients (17.2%) died. Most analysed scores substantially overestimated the mortality risk, especially in survivors. The prognostic accuracy of the scales were suboptimal, varying between 60% and 80%, with the best performance from Barcelona Bio-Heart Failure and Seattle Heart Failure Model for 1-5 year mortality [areas under the receiver operating curve 0.792-0.890 (95% confidence interval 0.725-0.918) and 0.764-0.808 (95% confidence interval 0.682-0.934), respectively].Based on our accumulated data, a self-developed DCM prognostic model was constructed. The model consists of age, gender, body mass index, symptoms duration, New York Heart Association class, diabetes mellitus, prior stroke, abnormal liver function, dyslipidaemia, left bundle branch block, left ventricle end-diastolic diameter, ejection fraction, N terminal pro brain natriuretic peptide, haemoglobin, estimated glomerular filtration rate, and pharmacological and resynchronisation therapy. This newly created prognostic model outperformed the analysed HF scales. Conclusions An analysis of various HF prognostic models found them to be suboptimal for DCM patients. A self-developed DCM prognostic model showed improved performance over the nine other models studied. However, further validation of the prognostic model in different DCM populations is required.

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Section: The Development Of a Mortality Calculator Tailored For Dilatsupporting

confidence: 60%

Mortality risk in dilated cardiomyopathy: the accuracy of heart failure prognostic models and dilated cardiomyopathy‐tailored prognostic model

et al. 2020

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“…However, much of our knowledge on cardiac disease is still based on studies done in males, and even today much experimental work in animal studies neglects females. The prevalence of dilated cardiomyopathy is higher in men, with both historic and current studies showing a ratio of 25-30% of women, compared with 70-75% men [3,[74][75][76][77]. Women are older at diagnosis by 1-3 years compared with men, and are more likely to present with heart failure and left bundle branch block [74][75][76].…”

Section: Sex and Gender Differences In Rbm20 Cardiomyopathymentioning

confidence: 99%

New Insights in RBM20 Cardiomyopathy

Lennermann

Backs

Hoogenhof

2020

Curr Heart Fail Rep

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Purpose of Review This review aims to give an update on recent findings related to the cardiac splicing factor RNA-binding motif protein 20 (RBM20) and RBM20 cardiomyopathy, a form of dilated cardiomyopathy caused by mutations in RBM20. Recent Findings While most research on RBM20 splicing targets has focused on titin (TTN), multiple studies over the last years have shown that other splicing targets of RBM20 including Ca2+/calmodulin-dependent kinase IIδ (CAMK2D) might be critically involved in the development of RBM20 cardiomyopathy. In this regard, loss of RBM20 causes an abnormal intracellular calcium handling, which may relate to the arrhythmogenic presentation of RBM20 cardiomyopathy. In addition, RBM20 presents clinically in a highly gender-specific manner, with male patients suffering from an earlier disease onset and a more severe disease progression. Summary Further research on RBM20, and treatment of RBM20 cardiomyopathy, will need to consider both the multitude and relative contribution of the different splicing targets and related pathways, as well as gender differences.

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“…It is important to underline that the activation of the estrogen receptors, mostly found in women, by 17β-estradiol prevents the apoptosis of cardiomyocyte, inhibits cardiac damage induced by reactive oxygen species, and reduces cardiac hypertrophy and fibrosis [42]. In a recent work by Cannatà et al, female sex resulted, in a large population of DCM patients (n = 1113 of total prospectively enrolled patients; n = 586 selected for analysis), as an independent favorable predictor for long-term cardiovascular outcomes (including cardiovascular mortality/need for heart transplantation or ventricular assist device) [43].…”

Section: Sex-related Differences In Mechanisms Of Dcmmentioning

confidence: 99%

Sex-Related Differences in Dilated Cardiomyopathy with a Focus on Cardiac Dysfunction in Oncology

et al. 2020

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Purpose of Review The aim of this report is to describe the main aspects of sex-related differences in non-ischemic dilated cardiomyopathies (DCM), focusing on chemotherapy-induced heart failure (HF) and investigating the possible therapeutic implications and clinical management applications in the era of personalized medicine. Recent Findings In cardio-oncology, molecular and multimodality imaging studies confirm that sex differences do exist, affecting the therapeutic cardioprotective strategies and, therefore, the long-term outcomes. Interestingly, compelling evidences suggest that sex-specific characteristics in drug toxicity might predict differences in the therapeutic response, most likely due to the tangled interplay between cancer and HF, which probably share common underlying mechanisms. Summary Cardiovascular diseases show many sex-related differences in prevalence, etiology, phenotype expression, and outcomes. Complex molecular mechanisms underlie this diverse pathological manifestations, from sex-determined differential gene expression to sex hormone interaction with their receptors in the heart. Non-ischemic DCM is an umbrella definition that incorporates several etiologies, including chemotherapy-induced cardiomyopathies. The role of sex as a risk factor for cardiotoxicity is poorly explored. However, understanding the various features of disease manifestation and outcomes is of paramount importance for a prompt and tailored evaluation.

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Sex Differences in the Long-term Prognosis of Dilated Cardiomyopathy

Cited by 51 publications

References 31 publications

Mortality risk in dilated cardiomyopathy: the accuracy of heart failure prognostic models and dilated cardiomyopathy‐tailored prognostic model

Mortality risk in dilated cardiomyopathy: the accuracy of heart failure prognostic models and dilated cardiomyopathy‐tailored prognostic model

New Insights in RBM20 Cardiomyopathy

Sex-Related Differences in Dilated Cardiomyopathy with a Focus on Cardiac Dysfunction in Oncology

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