LAUSR

AIMS To evaluate the association between sex and ventricular arrhythmias (VA) or sudden death (SD) in non-ischemic dilated cardiomyopathy, including analysis of potential confounders. METHODS Retrospective cohort study of consecutive patients with DCM referred for cardiac magnetic resonance (CMR) at two tertiary hospitals. The primary combined endpoint encompassed sustained VA, appropriate ICD therapies, resuscitated cardiac arrest and SD. RESULTS We included 1165 patients with median follow-up of 36 months (interquartile range 20-58 months). The majority of patients (66%) were males. Males and females had similar LVEF but the prevalence of late gadolinium enhancement (LGE) at CMR was significantly higher among males (48% vs 30%, p<0.001). Males had higher cumulative incidence of the primary endpoint (8% vs 4%, p=0.02) and male sex was a significant predictor of the primary endpoint at univariate analysis (HR 1.93, p=0.02). However, LGE had a major confounding effect in the association between sex and the primary outcome: the HR of male sex adjusted for LGE was 1.29 (p=0.37). LGE+ females had significantly higher cumulative incidence of the primary endpoint than LGE- males (13% vs 1.8%, p<0.001). CONCLUSIONS In patients with DCM, the prevalence of LGE is significantly higher among males, implying a major confounding effect in the association between male sex and VA or SD. LGE+ females have significantly higher risk than LGE- males. These data do not support the inclusion of sex into risk-stratification algorithms for VA or SD in DCM.