799-1 Gender-Related Differences in Functional and Morphologic Features in Idiopathic Dilated Cardiomyopathy

• Published in: Journal of the American College of Cardiology 1995-02, Vol.25 (2), p.385A-385A
• Main Authors: Pelliccia, Francesco, d’Amati, Giulia, Cianfrocca, Cinzia, De Castro, Stefano, Bernucci, Paola, Gallo, Pietro, Critelli, Giuseppe
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)93053-F

Recent studies have shown that a paradox occurs in ischemic heart disease, as women (W) show a higher incidence of heart failure than men (M) despite similar LV ejection fractions. Aim of this study was to verify whether such a “gender paradox” also exists in idiopathic dilated cardiomyopathy (IDC) and, if so, which are the possible underlying factors. Accordingly, we analyzed the clinical, ECG, echocardiographic, hemodynamic and LV histomorphometric features of 75 IDC patients (48 M and 27 W), consecutively referred to our Unit for invasive evaluation. W were older (55±9 vs 45±11 yrs, p<0.005), more symptomatic (NYHA class III or IV in 63 vs 35%, p<0.05), and had more frequent signs of heart failure (70 vs 42%, p<0.04), as compared with M. At echocardiography, the two groups had similar LV diameter, volume and mass. Doppler examination, however, showed that W had a lower ratio of transmitral early to late peak filling waves than M (1.0±0.3 vs 1.4±0.4, p<0.001), thus indicating a worse LV diastolic filling dynamics. At catheterization, W showed higher mean pulmonary artery pressure (25±9 vs 19±8mmHg, p<0.005). and LV end-diastolic pressure (21±7 vs 16±8mmHg, p<0.01) than M, whereas LV ejection fraction and cardiac index were similar in both genders. Comparison of LV histomorphometric features did not show any difference in myocellular area, nuclear area, and myofibril volume fraction. Conversely, W had larger interstitial fibrosis (12±6 vs 7±5%, p<0.001), and endocardial fibrosis (15±5 vs 8±6%, p<0.001), as compared with M. It is concluded that: (1) the paradox observed in ischemic heart disease of more frequent symptoms and signs of heart failure in W than in M occurs also in IDC; (2) such “gender paradox” relates to differences between W and M in LV diastolic function, rather than in cardiac contractility; (3) the association of female gender with a larger accumulation of cardiac fibrous tissue seems to constitute the morphologic substrate of the phenomenon.