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Updated: Jan 19, 2026
Cardiomyopathy II: Dilated Cardiomyopathy
Published on: June 19, 2025
Sex Differences in the Long-term Prognosis of Dilated Cardiomyopathy
Antonio Cannatà1, Enrico Fabris1, Marco Merlo1
1Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy.
Insights
Men with dilated cardiomyopathy (DCM) have a worse long-term prognosis than women. Male sex is an independent predictor of adverse cardiovascular outcomes in DCM patients, highlighting sex as a crucial prognostic factor.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Prognostics
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Long-term sex-based differences in DCM prognosis remain largely unexplored.
- Understanding these differences is crucial for tailored patient management.
Purpose of the Study:
- To investigate the long-term prognostic impact of sex in a large cohort of dilated cardiomyopathy patients.
- To determine if gender influences outcomes such as mortality, heart transplantation, or ventricular assist device implantation.
- To identify sex as an independent prognostic factor in DCM.
Main Methods:
- Prospective enrollment of 1113 DCM patients.
- Propensity score-matching analysis on 586 patients to balance baseline characteristics.
- Utilized univariable/multivariable Cox models and competing-risk analyses.
- Assessed outcomes including all-cause mortality, cardiovascular mortality, heart transplantation (HTx), ventricular assist device (VAD) implantation, sudden cardiac death, and malignant ventricular arrhythmias.
Main Results:
- Male sex was independently associated with adverse outcomes in the total cohort.
- In propensity-matched analysis (median 126 months follow-up), men showed higher rates of all-cause mortality/HTx/VAD (33% vs 22%) and cardiovascular mortality/HTx/VAD (32% vs 20%) compared to women.
- Men also had a trend towards higher rates of sudden cardiac death/malignant ventricular arrhythmias (16% vs 10%).
Conclusions:
- Women with DCM exhibit more favorable long-term outcomes compared to men.
- Sex is a significant independent prognostic factor in dilated cardiomyopathy.
- These findings underscore the importance of considering sex in predicting cardiovascular outcomes for DCM patients.
Background:
Dilated cardiomyopathy (DCM) represents a specific phenotype of heart failure. Sex differences in the long-term prognosis of patients with DCM are unknown. The aim of this study is to investigate the long-term prognostic role of gender in a large cohort of patients with DCM.
Methods:
A total of 1113 patients with DCM were prospectively enrolled. To investigate the impact of sex, a propensity score-matching analysis was performed on a sample of 586 patients. Univariable and multivariable Cox models and competing-risk analyses were estimated on both cohorts for the following outcome measures: (1) all-cause mortality/heart transplantation (HTx)/ventricular assist device (VAD); (2) cardiovascular mortality/HTx/VAD; and (3) sudden cardiac death or malignant ventricular arrhythmias.
Results:
Women were older than men (50 ± 15 years vs 47 ± 15 years, respectively, P = 0.004) and more frequently had moderate to severe left ventricular dilation (P < 0.001) and left bundle branch block (P = 0.019). At multivariable analyses, male sex was independently associated with all considered outcome measures in the total cohort. At propensity score-matching analysis, over a median follow-up of 126 months (interquartile range, 62-201), 96 men (33%) vs 66 women (22%) experienced all-cause mortality/HTx/VAD (P = 0.03), 95 men (32%) vs 57 women (20%) experienced cardiovascular mortality/HTx/VAD (P = 0.025), and 46 men (16%) vs 28 women (10%) experienced sudden cardiac death/malignant ventricular arrhythmias (P = 0.07).
Conclusion:
The long-term outcomes of women affected by DCM are more favourable than those of men, and sex emerged as an important independent factor, particularly for cardiovascular outcomes.
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