Ventricular Arrhythmias and Sudden Death in Nonischemic Dilated Cardiomyopathy: Matter of Sex or Scar?

• Published in: Journal of cardiac failure 2022-08, Vol.28 (8), p.1278-1286
• Main Authors: Di-marco, ANDREA, BROWN, PAMELA FRANCES, CLAVER, EDUARD, BRADLEY, JOSHUA, NUCIFORA, GAETANO, RUIZ-CUETO, MARÍA, DALLAGLIO, PAOLO DOMENICO, RODRIGUEZ, MARCOS, COMIN-COLET, JOSEP, ANGUERA, IGNASI, MILLER, CHRISTOPHER A., SCHMITT, MATTHIAS
• Format: Article
• Language: English
• Subjects: Arrhythmias, Cardiac; cardiac magnetic resonance; Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - diagnosis; Cicatrix - complications; Contrast Media; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Female; Gadolinium; Heart Failure - complications; Humans; late gadolinium enhancement; Magnetic Resonance Imaging, Cine - methods; Male; nonischemic dilated cardiomyopathy; Predictive Value of Tests; Retrospective Studies; Sex; Stroke Volume; sudden death; ventricular arrhythmias; Ventricular Function, Left
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.01.019

•In patients with nonischemic dilated cardiomyopathy (DCM), late gadolinium enhancement (LGE) is significantly more frequent in males and acts as a major confounder in the association between sex and ventricular arrhythmias (VA) or sudden death (SD): after adjusting for LGE, male sex is no longer associated with higher risk of VA or SD.•Female LGE+ patients with DCM are at considerable risk of VA or SD, similarly to male LGE+ cases. Their risk is significantly higher as compared with LGE– males•Male patients with DCM but without LGE have low risk of VA or SD, exactly like female LGE– cases. To evaluate the association between sex and ventricular arrhythmias (VA) or sudden death (SD) in nonischemic dilated cardiomyopathy, including analysis of potential confounders. Retrospective cohort study of consecutive patients with DCM referred for cardiac magnetic resonance at 2 tertiary hospitals. The primary combined end point encompassed sustained VA, appropriate implantable cardioverter defibrillator therapies, resuscitated cardiac arrest, and SD. We included 1165 patients with median follow-up of 36 months (interquartile range 20–58 months). The majority of patients (66%) were males. Males and females had similar left ventricular ejection fraction, but the prevalence of late gadolinium enhancement (LGE) at cardiac magnetic resonance was significantly higher among males (48% vs 30%, P < .001). Males had higher cumulative incidence of the primary end point (8% vs 4%, P = .02), and male sex was a significant predictor of the primary end point at univariate analysis (hazard ratio 1.93, P = .02). However, LGE had a major confounding effect in the association between sex and the primary outcome: the hazard ratio of male sex adjusted for LGE was 1.29 (P = .37). LGE+ females had significantly higher cumulative incidence of the primary end point than LGE– males (13% vs 1.8%, P < .001). In patients with DCM, the prevalence of LGE is significantly higher among males, implying a major confounding effect in the association between male sex and VA or SD. LGE+ females have significantly higher risk than LGE– males. These data do not support the inclusion of sex into risk stratification algorithms for VA or SD in DCM.