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Gender differences in myocardial reverse remodeling after guideline-directed medical therapy in dilated cardiomyopathy
Session:
SESSÃO DE POSTERS 18 - MIOCARDIOPATIA DILATADA
Speaker:
Pedro Mangas Palma
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Pedro Miguel Mangas Neto da Palma; Maria Miguel Fernandes; Inês Fortuna; Luís Santos; Ana Pinho; Catarina Marques; Paulo Araújo; Xavier Resende; Sandra Amorim; Manuel Campelo; J. Silva Cardoso; Elisabete Martins
Abstract
<p><strong>Introduction</strong></p> <p>The prognosis of patients with dilated cardiomyopathy (DCM) has improved with guideline-directed medical therapy (GDMT), which promotes myocardial reverse remodeling and reduces morbidity and mortality.</p> <p>Male gender is consistently associated with higher rates of sudden cardiac death, heart failure-related mortality, and transplant in DCM cohorts. These gender differences in outcomes are driven by genetic, hormonal and potentially treatment-related factors. Gender differences in response to GDMT may contribute to these disparities, but data on this topic are scarce.</p> <p><strong>Purpose</strong> </p> <p>To assess and characterize gender-based differences in response to GDMT in patients with DCM.</p> <p><strong>Methods</strong></p> <p>We conducted a single-center retrospective cohort study, including patients diagnosed with DCM according to the 2023 ESC Guidelines for the Management of Cardiomyopathies proposed criteria since 2019.</p> <p>Comprehensive data, including clinical evaluations, laboratory findings, echocardiographic parameters, and cardiac MRI results, were collected at baseline and following the initiation of guideline-directed medical therapy (GDMT), with a minimum interval of 12 months between assessments. Left ventricular (LV) remodeling was defined as an increase in left ventricular ejection fraction (LVEF) of ≥10 percentage points.</p> <p><strong>Results</strong></p> <p>A total of 64 patients (mean age 51.2 ± 15.4 years; 41% female) were followed for an average of 7.3 years. Pathogenic genetic variants were identified in 36% of patients, with TTN (48%) and FLNC (17%) being the most frequent. Atrial fibrillation was observed in 14% of patients, and 18% had complete left bundle branch block.</p> <p>GDMT was widely implemented: 94% of patients received ACE inhibitors or ARNI (57% ARNI), 92% were on beta-blockers, 83% on SGLT2 inhibitors, and 69% on MRA. The mean baseline LVEF was 36.1% (35.50% ± 1.60 in females vs. 36.9% ± 2.16 in males), which improved to 40.1% after GDMT (40.3% ± 1.69 in females vs. 39.7% ± 1.87 in males).</p> <p>Overall, 42% of patients met the criteria for LV reverse remodeling, with a higher prevalence in females (45.9%) compared to males (37.1%). Conversely, 14% of patients experienced significant disease progression (LVEF decrease of ≥10 percentage points), predominantly affecting males (60%).</p> <p><strong>Conclusion</strong></p> <p>This study highlights gender-based differences in myocardial response to GDMT in DCM. Females showed higher rates of reverse remodeling and lower rates of disease progression compared to males. These findings underscore the need for gender-specific approaches to optimize DCM management and outcomes.</p>
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