Sex- specific differences in suspected myocarditis presentations and outcomes

• Published in: International journal of cardiology 2025-01, Vol.418, p.132593, Article 132593
• Main Authors: Schütze, Jonathan, Greisser, Noah, Joss, Philippe, Gebhard, Catherine, Bernhard, Benedikt, Greulich, Simon, Stark, Anselm W., Safarkhanlo, Yasaman, Pavlicek, Maryam, Hundertmark, Moritz, Shiri, Isaac, Kwong, Raymond, Gräni, Christoph
• Format: Article
• Language: English
• Subjects: Adult; Aged; CMR; Female; Follow-Up Studies; Gender differences; Heart failure; Hospitalization - statistics & numerical data; Humans; MACE; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Myocarditis; Myocarditis - diagnosis; Myocarditis - diagnostic imaging; Myocarditis - epidemiology; Retrospective Studies; Sex Characteristics; Sex differences; Sex Factors
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2024.132593

Signs and symptoms of myocarditis may vary among men and women. This study aimed to analyze sex-specific differences in the presentation and outcomes of patients with suspected myocarditis. Patients meeting clinical ESC criteria for suspected myocarditis were included from two tertiary centers between 2002 and 2021. Baseline characteristics, cardiac magnetic resonance (CMR), and outcomes (i.e. major adverse cardiovascular events (MACE), including all-cause death, ventricular tachycardia, hospitalization for heart failure, and recurrent myocarditis) in women and men were compared. 776 consecutive patients (mean age 48 ± 16 years, 286 [36.9 %] women) were followed for a median of 3.7 years. Compared to men, women presented more often with severe dyspnea (NYHA III-IV: 25.9 % versus 19.2 % of men; p = 0.029), while chest pain was more frequent in men (39.8 % versus 32.2 % in women; p = 0.037). There was no difference in left ventricular ejection fraction at the time of presentation (women: 48.5 ± 15.4 % versus men: 48.6 ± 15.1 %;p = 0.954). Further, no sex-specific difference in the occurrence of MACE was noted; however, women were more often hospitalized for heart failure than men (women: 9.8 % versus men: 5.3 %, p = 0.018). Accordingly, female sex was independently associated with heart failure hospitalization in an adjusted model (HR: 2.31, 95 % CI:1.25–4.26; p = 0.007). The prognostic value of CMR markers was similar in both sex. Significant sex-specific differences in presentations and imaging findings are found in patients with suspected myocarditis. Female sex is associated with a twofold increase in the risk of heart failure hospitalization, which should be considered in risk stratification. Central Illustration: Sex-differences in presentation and outcome in patients with myocarditis. Abbreviations:BMI: body mass index, CI: confidence intervals, HR: hazard ratio, LGE: late gadolinium enhancement, LVEF: left ventricular ejection fraction. [Display omitted] •Female sex independently predicts heart failure hospitalizations but not MACE, needing sex-specific care approaches.•Women often present with dyspnea and show higher ECV but less LGE on CMR compared to men, without LVEF differences.•More research is needed to address sex differences in myocarditis to improve personalized risk stratification and outcomes.