Sex- specific differences in suspected myocarditis presentations and outcomes.

BACKGROUND

Signs and symptoms of myocarditis may vary among men and women.

OBJECTIVES

This study aimed to analyze sex-specific differences in the presentation and outcomes of patients with suspected myocarditis.

METHODS

Patients meeting clinical ESC criteria for suspected myocarditis were included from two tertiary centers between 2002 and 2021. Baseline characteristics, cardiac magnetic resonance (CMR), and outcomes (i.e. major adverse cardiovascular events (MACE), including all-cause death, ventricular tachycardia, hospitalization for heart failure, and recurrent myocarditis) in women and men were compared.

RESULTS

776 consecutive patients (mean age 48 ± 16 years, 286 [36.9 %] women) were followed for a median of 3.7 years. Compared to men, women presented more often with severe dyspnea (NYHA III-IV: 25.9 % versus 19.2 % of men; p = 0.029), while chest pain was more frequent in men (39.8 % versus 32.2 % in women; p = 0.037). There was no difference in left ventricular ejection fraction at the time of presentation (women: 48.5 ± 15.4 % versus men: 48.6 ± 15.1 %;p = 0.954). Further, no sex-specific difference in the occurrence of MACE was noted; however, women were more often hospitalized for heart failure than men (women: 9.8 % versus men: 5.3 %, p = 0.018). Accordingly, female sex was independently associated with heart failure hospitalization in an adjusted model (HR: 2.31, 95 % CI:1.25-4.26; p = 0.007). The prognostic value of CMR markers was similar in both sex.

CONCLUSION

Significant sex-specific differences in presentations and imaging findings are found in patients with suspected myocarditis. Female sex is associated with a twofold increase in the risk of heart failure hospitalization, which should be considered in risk stratification.

Informations de copyright

Copyright © 2024. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of competing interest B. Bernhard report a career development grant from the Swiss National Science Foundation. C. Gebhard was supported by grants from the Swiss National Science Foundation (SNSF), the Olga Mayenfisch Foundation, Switzerland, the OPO Foundation, Switzerland, the Novartis Foundation, Switzerland, the Swissheart Foundation, the Helmut Horten Foundation, Switzerland, the EMDO Foundation, the Iten-Kohaut Foundation, Switzerland, the University Hospital Zurich Foundation, the University of Zurich (UZH) Foundation, and the LOOP, Zurich. R. Kwong has received research support from Bristol Myers Squibb, Alnylam Pharmaceuticals, Epirium Bio, and Bayer AG, outside of the submitted work. C. Gräni has no conflict of interest with regard to the current study. C. Gräni received funding from the Swiss National Science Foundation, Swissheart Foundation, InnoSuisse, CAIM foundation and GAMBIT foundation, outside of the submitted work. C. Gräni is Editor-in Chief, beginning 01/2024 of the International Journal of Cardiovascular Imaging. All other authors report no relationships that could be construed as a conflict of interest.