Key result
Men with DCM show worse LV and RV dysfunction and lower peak VO2 than women.
Why the study?
Precise characterisation of clinical and imaging phenotypes in dilated cardiomyopathy remains incomplete, with a notable lack of research concerning sex differences despite worse prognosis in men.
Do male and female patients with dilated cardiomyopathy exhibit differences in functional capacity and haemodynamic features despite similar clinical characteristics?
Observational (n=58)
No
Do male and female patients with dilated cardiomyopathy exhibit differences in functional capacity and haemodynamic features despite similar clinical characteristics?
Despite similar clinical characteristics, men with dilated cardiomyopathy exhibit worse haemodynamic and cardiopulmonary features compared to women, highlighting the need for sex-specific pathophysiological investigation.
Sex differences in DCM functional capacity may inform risk assessment; hypothesis-generating for sex-specific mechanisms.
Background/Introduction Dilated cardiomyopathy (DCM), defined by left ventricular dilatation and systolic dysfunction, is the most prevalent form of cardiomyopathy which may lead to chronic heart failure (HF). However, precise characterisation of clinical and imaging phenotypes remains incomplete. While HF has been extensively studied in literature, there is a notable lack of research on DCM, particularly concerning sex differences. DCM is more prevalent in men than in women, and it is well-known that men experience a worse prognosis, characterized by higher all-cause and cardiovascular mortality rates and an increased risk of sudden cardiac death. Purpose This study aims to integrate echocardiographic, cardiac magnetic resonance (CMR), and cardiopulmonary exercise testing (CPET) data to deepen the understanding of sex differences in DCM. Methods After excluding patients with incomplete data, the study involved 58 DCM patients referred to our outpatient cardiology clinic. Two cohorts of male and female patients were compared, matched for age, symptom perception, HF bio-humoral markers, treatments, and cardiovascular risk factors. Results Despite similar demographic, clinical, and bio-humoral characteristics and left ventricular stroke volume indexed (LV SVi) at rest, men exhibited a more advanced LV dysfunction, biventricular dilatation and dysfunction compared to women- see Picture1. Furthermore, men showed greater right ventricle-pulmonary artery uncoupling. In terms of exercise functional capacity, women demonstrated greater aerobic capacity, as reflected in higher peak oxygen consumption (peak VO2) values, expressed as percentage of the predicted value normalized for age, sex, and height, as well as improved oxygen pulse. Additionally, men exhibited an increased minute ventilation to carbon dioxide production (VE/VCO2) slope. Although no significant differences were found in the presence or extent of late gadolinium enhancement (LGE) between the sexes, there was a trend towards a larger septal localization of LGE in men compared to women. Conclusions This study reveals significant sex differences in patients with DCM: men exhibited poorer haemodynamic and cardiopulmonary findings. The investigation of the pathophysiological bases of these differences could provide a more comprehensive characterization of DCM patients leading to more personalized management strategies.
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Giardino et al. (2025) conducted an observational in Dilated cardiomyopathy (DCM) (n=58). Male sex vs. Female sex was evaluated on Echocardiographic, cardiac magnetic resonance (CMR), and cardiopulmonary exercise testing (CPET) parameters. Male patients with dilated cardiomyopathy exhibited more advanced biventricular dysfunction, greater right ventricle-pulmonary artery uncoupling, and lower aerobic capacity compared to matched females.
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