Abstract
Background: There is limited data on gender specific remodeling and its associated risk in patients with ischemic cardiomyopathy (ICM). We conducted gender based phenomapping analysis using Cardiac MRI (CMR) variables to identify novel sex-specific phenotypes in patients with ICM. We then assessed if these phenotypes were predictive of overall survival. Methods: Patients with ICM who underwent CMR between January 2002 and January 2017, were retrospectively evaluated . Cluster analysis was performed using nearest centroid sorting with nine variables: left ventricular end systolic volume index (LVESVi), mitral regurgitation severity on CMR (MR) , left atrial volume index (LAVi), right ventricular ejection fraction (RVEF), RV end diastolic volume index (RVEDVi) , LVEF, LV mass index (LVmassi), left atrial ejection fraction (LAEF), and myocardial scar burden (Scar). For each cluster size a Cox proportional hazards model was used to test if the phenotypes were predictive of survival. Results: Data was analyzed from 407 males and 119 females. The optimal number of clusters was four, based on the ability of the phenotypes to predict overall survival. Phenotype was a statistically significant predictor of overall survival in men (p=0.002) and women (p=0.016) after adjusting for age, body mass index, renal function, hypertension, diabetes, revascularization and mitral valve intervention. (Figure 1a) These distinct phenotypes predicted survival differently in men compared to women. Of interest, there were significant differences in the contribution of each CMR variable to predict the phenotype based on sex. (Figure 1b) In females, CMR MR and RVEF were stronger contributors to the phenotype. Conclusion: Significant differences in phenotypic signatures based on gender are present in patients with ICM. These distinct phenotypes predicted survival differently in men compared to women and emphasizes the importance of sex specific risk stratification in the ICM cohort.
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