Sex-Specific Prognostic Implications in Dilated Cardiomyopathy After Left Ventricular Reverse Remodeling

Cannatà, Antonio; Manca, Paolo; Nuzzi, Vincenzo; Gregorio, Caterina; Artico, Jessica; Gentile, Piero; Loco, Carola Pio; Ramani, Federica; Barbati, Giulia; Merlo, Marco; Sinagra, Gianfranco

doi:10.3390/jcm9082426

Cited by 13 publications

(12 citation statements)

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“…8 This finding was further confirmed in populations of non-ischaemic DCM, where males were more susceptible to develop disease characterized by poor outcome, regardless of the response to therapy. 2,9 Conversely, women frequently exhibit stronger innate and adaptive immune responses than men, and this could theoretically contribute to their increased susceptibility to inflammatory and autoimmune diseases. 10 The aim of the present study, therefore, was to investigate the potential impact of sex in the clinical presentation and long-term follow-up in a large cohort of unselected patients with a definite diagnosis of myocarditis.…”

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confidence: 99%

Sex differences in natural history of cardiovascular magnetic resonance‐ and biopsy‐proven lymphocytic myocarditis

et al. 2022

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Aims The role of sex in determining the profile and the outcomes of patients with myocarditis is largely unexplored. We evaluated the impact of sex as a modifier factor in the clinical characterization and natural history of patients with definite diagnosis of myocarditis. Methods and results We retrospectively analysed a single‐centre cohort of consecutive patients with definite diagnosis of myocarditis (i.e. endomyocardial biopsy or cardiac magnetic resonance proven). Specific sub‐analyses were performed in cohorts of patients with chest pain, ventricular arrhythmias, and heart failure as different main symptoms at presentation. The primary outcome measure was a composite of all‐cause mortality or heart transplantation (HTx). We included 312 patients, of which 211, 68% of the whole population, were males. Despite no clinically relevant differences found at baseline presentation, males had a higher indexed left ventricular end‐diastolic volume (62 ± 23 mL/m2 vs. 52 ± 20 mL/m2, P = 0.011 in males vs. females, respectively) at follow‐up evaluation. At a median follow‐up of 72 months, 36 (17%) males vs. 8 (8%) females experienced death or HTx (P = 0.033). Male sex emerged as predictors of all‐cause mortality or HTx in every combination of covariates (HR 2.600; 1.163–5.809; P = 0.020). Results were agreeable regardless of the main symptom of presentation. Conclusions In a large cohort of patients with definite diagnosis of myocarditis, females experienced a more favourable long‐term prognosis than males, despite a similar clinical profile at presentation.

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Section: Introductionmentioning

confidence: 99%

Sex differences in natural history of cardiovascular magnetic resonance‐ and biopsy‐proven lymphocytic myocarditis

et al. 2022

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“…Although it is well‐known that male sex has important prognostic impact in patients with NI‐DCM. 31 , 32 Our results do not allow to draw a conclusion regarding the influence of sex on the outcome, due to the high rate of breast cancers that are proper of female patients.…”

Section: Discussionmentioning

confidence: 69%

Clinical characterization and natural history of chemotherapy‐induced dilated cardiomyopathy

et al. 2022

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Aims Chemotherapy-induced dilated cardiomyopathy (CI-DCM) is a well-recognized phenotype of non-ischemic dilated cardiomyopathy (DCM), characterized by poor outcomes. However, a detailed comparison between idiopathic DCM (iDCM) and CI-DCM is still lacking. Methods and resultsAll consecutive DCM patients enrolled in the Trieste Muscle Heart Disease Registry were analysed. CI-DCM and iDCM were defined according to current recommendations. The primary study outcome measure was all-mortality death and secondary outcomes were a) a composite of cardiovascular death/heart-transplantation/ventricularassist-device implantation, and b) major ventricular arrhythmias. The study included 551 patients (499 iDCM and 52 CI-DCM). At enrolment, compared with iDCM, CI-DCM patients were older (51 ± 14 years vs. 58 ± 3 years, respectively, P < 0.001) and had a higher left ventricular ejection fraction (32% ± 9 vs. 35% ± 10, respectively, P = 0.03). Over a median follow-up of 90 months (IQR 54-140 months), CI-DCM patients had a higher incidence of all-cause mortality compared with iDCM (36.5% vs. 8.4% in CI-DCM and iDCM respectively, P < 0.001), while the incidence of major ventricular arrhythmias was higher in the iDCM group compared with CI-DCM (4% vs. 0%, in CI-DCM and iDCM respectively, P = 0.03). The risk of the composite outcome was comparable between the two groups (P = 0.91). At Cox multivariable analysis, the diagnosis of CI-DCM emerged as independently associated to primary outcome (HR 6.42, 95% C.I. 2.52-16.31, P < 0.001). Conclusions In a well-selected DCM cohort, patients with a chemotherapy-induced aetiology had a higher incidence of all-cause mortality compared with iDCM. Conversely, the incidence of life-threatening ventricular arrhythmic events was higher among patients with iDCM.

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“…It is important to highlight that our results differ from those of earlier studies. In one study, it was shown that natriuretic peptides may be useful in predicting LVRR; in another, a large variance in LVRR incidence between men and women was found ( 20 ). Natriuretic peptides and sex differences were shown by the findings of our study not to be useful in predicting LVRR.…”

Section: Discussionmentioning

confidence: 99%

Early prediction of clinical scores for left ventricular reverse remodeling using extreme gradient random forest, boosting, and logistic regression algorithm representations

Liu

Qiao

Zha

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveAt present, there is no early prediction model of left ventricular reverse remodeling (LVRR) for people who are in cardiac arrest with an ejection fraction (EF) of ≤35% at first diagnosis; thus, the purpose of this article is to provide a supplement to existing research.Materials and methodsA total of 109 patients suffering from heart attack with an EF of ≤35% at first diagnosis were involved in this single-center research study. LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) from ≥10% to a final value of >35%, with analysis features including demographic characteristics, diseases, biochemical data, echocardiography, and drug therapy. Extreme gradient boosting (XGBoost), random forest, and logistic regression algorithm models were used to distinguish between LVRR and non-LVRR cases and to obtain the most important features.ResultsThere were 47 cases (42%) of LVRR in patients suffering from heart failure with an EF of ≤35% at first diagnosis after optimal drug therapy. General statistical analysis and machine learning methods were combined to exclude a number of significant feature groups. The median duration of disease in the LVRR group was significantly lower than that in the non-LVRR group (7 vs. 48 months); the mean values of creatine kinase (CK) and MB isoenzyme of creatine kinase (CK-MB) in the LVRR group were lower than those in the non-LVRR group (80.11 vs. 94.23 U/L; 2.61 vs. 2.99 ng/ml; 27.19 vs. 28.54 mm). Moreover, AUC values for our feature combinations ranged from 97 to 94% and to 87% when using the XGBoost, random forest, and logistic regression techniques, respectively. The ablation test revealed that beats per minute (BPM) and disease duration had a greater impact on the model’s ability to accurately forecast outcomes.ConclusionShorter disease duration, slightly lower CK and CK-MB levels, slightly smaller right and left ventricular and left atrial dimensions, and lower mean heart rates were found to be most strongly predictive of LVRR development (BPM).

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Sex-Specific Prognostic Implications in Dilated Cardiomyopathy After Left Ventricular Reverse Remodeling

Cited by 13 publications

References 23 publications

Sex differences in natural history of cardiovascular magnetic resonance‐ and biopsy‐proven lymphocytic myocarditis

Sex differences in natural history of cardiovascular magnetic resonance‐ and biopsy‐proven lymphocytic myocarditis

Clinical characterization and natural history of chemotherapy‐induced dilated cardiomyopathy

Early prediction of clinical scores for left ventricular reverse remodeling using extreme gradient random forest, boosting, and logistic regression algorithm representations

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