Sex Differences in Chagas Cardiomyopathy: a Comprehensive Review.

Area of Science:

• Cardiology
• Immunology
• Genetics

Background:

• Chagas cardiomyopathy (CCC) is a primary cause of heart failure (HF) in Latin America.
• Sex-specific differences in HF presentation and outcomes in CCC are not well understood.

Purpose of the Study:

• To review current knowledge on clinical manifestations, HF phenotypes, and molecular mechanisms in women and men with CCC.
• To highlight sex-based disparities in Chagas cardiomyopathy.

Main Methods:

• Literature review of clinical manifestations, HF phenotypes, and molecular mechanisms in CCC.
• Analysis of sex-specific differences in disease presentation, progression, and molecular signatures.

Main Results:

• Men with CCC more frequently present with severe HF, arrhythmias, and sudden cardiac death.
• Women with CCC often exhibit milder HF phenotypes, slower progression, and varied HF subtypes (HFrEF, HFmrEF, HFpEF).
• Molecular studies reveal distinct inflammatory profiles: males show Th1 signatures, while females exhibit Th2 and Treg enrichment.

Conclusions:

• Significant sex-based differences exist in CCC presentation, HF phenotypes, and underlying molecular mechanisms.
• Hormonal and immune factors may contribute to milder disease progression in women.
• Sex-specific evaluation and management strategies are crucial for optimizing CCC care.