Abstract

 Objective. To evaluated possible clinical and instrumental, natural history and prognostic divergences in women and men with idiopathic dilated cardiomyopathy (IDCM).
 Patients and Methods. From 1988 to 2012, we evaluated 803 consecutive patients with IDCM recorded in the Heart Muscle Disease Registry of Trieste (Italy). All patients had serial follow-up evaluations at 6, 12, and 24 months, and subsequently every two years, or more frequently if clinically indicated.
 Results. Two hundred and twenty-seven patients (28%) were female. At first evaluation women were significantly older (48 vs. 45 years old, p = 0.008); presented more frequently left bundle branch block at ECG (38% vs. 28%, p = 0.01), smaller left ventricular end-diastolic indexed volume at echocardiography (85 vs. 93 ml/m2, p <0.002) and more frequently moderate to severe mitral regurgitation at Doppler (43% vs. 33%, p = 0.015). No differences in NYHA class, medical treatment and device implantation rates were found. During a median of 108 months follow-up, women showed a significantly lower ten-year total mortality/heart transplantation (20% vs. 32% respectively, p = 0.001) and cardiovascular mortality rates (9% vs. 15%, p = 0.024) despite a less marked clinical and echocardiographic improvement.
 Conclusions. In our population of patients with IDCM, women showed a better long-term prognosis notwithstanding a presentation with a more advanced disease and a lower clinical-instrumental improvement on optimal medical therapy compared to men. 
Highlights
Several gender differences exist in normal heart anatomy and physiology
Men have an increased left ventricle (LV) indexed mass, but female myocardial mass is better preserved with aging [1]; coronary vessels are smaller and LV ejection fraction (LVEF) is higher in women compared to men
Gender differences have been described in different heart failure populations in clinical trials and registries [9,10,11,12,13]; aetiology is different with a prevalence of ischemic heart disease and idiopathic dilated cardiomyopathy (IDCM) in men whereas hypertension and valvular heart disease are frequent risk factors in women
Summary
Several gender differences exist in normal heart anatomy and physiology. Women have lower blood pressure, faster resting heart rate and longer QTc interval than men [2]. Clinical and experimental evidence suggests that the pathogenesis and prognosis of many cardiovascular diseases differ between genders. Idiopathic dilated cardiomyopathy (IDCM) can be considered the most genetically heterogeneous cardiac disease, with mutations in more than 50 single genes encoding cytoskeletal, nuclear skeletal, mitochondrial, and calcium-handling proteins [3,4]. Other causes of IDCM (i.e. inflammatory or autoimmune) exist and preliminary data suggest that gender-related variations may account for some differences in epidemiology, left ventricular recovery, and survival between men and women with post-myocarditis IDCM, highlighting knowledge gaps in management of women with acute IDCM [3]
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