Abstract
Dilated cardiomyopathy (DCM) is the major cause of heart failure affecting both women and men. Limited clinical studies show conflicting data in sex-related differences in the progression of dilated cardiomyopathy and heart failure (HF) outcomes. We examined the comparative sex-related progression of cardiomyopathy and the development of HF (at 4, 7, 13 weeks of age) in a well-established, transgenic mouse model of DCM that recapitulates the progressive stages of human HF. By 13 weeks of age, female mice with DCM had more severe left ventricular systolic dysfunction, left ventricular dilation and wall thinning (P<0.001 for all) than age-matched male mice with DCM. Female mice also had greater lung edema (P<0.001), cardiac fibrosis (P<0.01) and pleural effusions, which were not rescued by ovariectomy. By comparison to DCM male mice at 13 weeks, these pathological changes in female mice with DCM, were associated with significant increases in plasma active renin (P<0.01), angiotensin II (P<0.01) and aldosterone levels (P<0.001). In comparison to DCM male mice, DCM female mice also showed differential expression of the natriuretic peptide system with lower corin and higher ANP, BNP and cGMP levels at 13 weeks of age. We conclude, that female mice with experimental DCM have an accelerated progression of cardiomyopathy and HF, which was not corrected by early ovariectomy. These alterations are associated with early renin activation with increased angiotensin II and aldosterone levels, and altered expression of the natriuretic peptide system.
Highlights
Dilated cardiomyopathy (DCM) is the major cause of heart failure (HF) [1,2] that affects more than 60% of HF patients [1,3]
In this study we examined the progression of cardiomyopathy and HF over time, in female mice by comparison to male mice with DCM
In DCM male mice, a less marked, timedependent decline in systolic function was evident in comparison with wild-type controls (Fig 1D and 1E), as we have previously described [19]
Summary
Dilated cardiomyopathy (DCM) is the major cause of heart failure (HF) [1,2] that affects more than 60% of HF patients [1,3]. DCM affects both men and women [2,4] and sex-related differences in survival have been reported previously [2,4,5,6,7,8], but the data on disease incidence, outcomes and survival are inconsistent [9,10,11,12,13,14]. Experimental data on diseases incidence, progression and HF outcomes in animal models are scarce. This experimental DCM mouse model appears to be the highly translationally relevant since the DCM mice are recapitulate pathological features of HF [15,16,17,18], and pass through all stages of HF [19], similar to humans [20]. Female mice with DCM have shorter survival than males, which has been attributed to more severe impairments in mitochondrial function in females evident at 12 weeks of age [16]
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