Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.
National Heart & Lung Institute, Imperial College, London, UK.
Eur J Heart Fail. 2018 Oct;20(10):1392-1400. doi: 10.1002/ejhf.1216. Epub 2018 Jun 3.
To evaluate the relationship between sex, age and outcome in dilated cardiomyopathy (DCM).
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/m vs. 135 mL/m ; 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.
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.
评估性别、年龄与扩张型心肌病（DCM）结局的关系。
我们使用比例风险模型来研究 DCM 连续患者中性别、年龄与全因死亡率之间的相关性。共有 881 例患者（290 例女性，中位年龄 52 岁）接受了中位时间为 4.9 年的随访。与男性相比，女性更易出现心力衰竭（64.0% vs. 54.5%；P=0.007），且症状更严重（P<0.0001）。女性的左心室舒张末期容积更小（125ml/m vs. 135ml/m；P<0.001），左心室射血分数更高（40.2% vs. 37.9%；P=0.019），且中壁晚期钆增强的发生率更低（23.0% vs. 38.9%；P<0.0001）。随访期间，149 例（16.9%）患者死亡，包括 41 例（4.7%）猝死。调整后，女性的全因死亡率[风险比（HR）0.61，95%置信区间（CI）0.41-0.92；P=0.018]较低，且心血管死亡率[HR 0.60，95%CI 0.35-1.05；P=0.07]、非猝死性死亡率[HR 0.63，95%CI 0.39-1.02；P=0.06]和猝死性死亡率[HR 0.70，95%CI 0.30-1.63；P=0.41]也有相似的降低趋势。全因死亡率（每 10 年：HR 1.36，95%CI 1.20-1.55；P<0.0001）和非猝死性死亡率（每 10 年：HR 1.51，95%CI 1.26-1.82；P<0.00001）随年龄增加而增加。累积发病率曲线证实了有利的结果，尤其是在女性和<60 岁的患者中。60 岁以上患者全因死亡率的增加是由非猝死性死亡驱动的。
与男性相比，女性 DCM 患者的生存率更好，这可能部分归因于左心室功能障碍程度较轻和瘢痕负荷较小。60 岁以上患者的全因死亡率增加是由非猝死性死亡驱动的，而女性的这种趋势不那么明显。在接受当代治疗的患者中，结局良好，猝死发生率较低。
