Men with sporadic arrhythmogenic right ventricular cardiomyopathy (ARVC) had higher risk of developing ventricular tachycardia (VT) and ventricular fibrillation (VF) compared with women. However, women had higher risk for heart failure-related death or heart transplantation, according to data recently published in JACC: Clinical Electrophysiology.
Previous research has suggested that ARVC may predominantly occur in males, although the gender impact on the heterogeneous clinical profiled and prognosis of ARVC has not been established. Therefore, researchers aimed to assess the gender-related differences in sporadic cases of ARVC.
They selected 110 patients with ARVC who met the revised Task Force criteria to be included in the study. Based on the task force criteria, a patient was considered to have ARVC if they fulfilled 1 of the 3 criteria, which included filtered QRS duration ≥114 ms, duration of the terminal QRS low-amplitude signals ≥38 ms, and root-mean-square voltage of the last 40 ms of the QRS complex ≤20 μV.
All patients had sporadic ARVC and no prior family history. The median age was 48 (36-57) years, approximately 75% were male, and 88% were considered to have “definite” ARVC based on the task force criteria. At baseline, the researchers found no significant gender-related differences in age, 12-lead electrocardiogram (ECG) findings, late potentials by signal-averaged ECG findings, left ventricular ejection fraction, or right ventricular ejection fraction.
After a median follow-up period of 10 years, 18 patients died from cardiac causes. Kaplan-Meier analysis showed that men had significantly higher risk of VT/VF compared with women (56% vs 90%; P=.02), and women had significantly higher risk of heart failure mortality or heart transplantation (22% vs 5%; P=.002).
Researchers also found that female gender was an independent risk factor of heart failure mortality or heart transplantation due to heart failure (hazard ratio: 6.29; 95% confidence interval: 1.29-40.2; P=.02).
Risk of heart failure hospitalization was also greater among women older than 50 years of age at baseline, as compared with younger women or male patients, which suggests that postmenopausal endocrine changes may affect the clinical course of ARVC.
“Recent developments in early diagnosis, risk stratification, and antiarrhythmic therapies should contribute to better prognosis and even freedom from potentially lethal ventricular arrhythmic events in patients with ARVC,” the authors wrote.
“However, intervention in the malignant progress of ARVC itself is still a challenging issue. Our study of sporadic ARVC demonstrated a female predominance in heart failure-related adverse outcomes, suggesting that we should pay careful attention to this possibility when treating female ARVC patients.”
Researchers also noted that future studies should investigate interventions, like exercise restriction and load reducing therapy, that could prevent heart failure-related adverse outcomes.
Kimura Y, Noda T, Otsuka Y, et al. Potentially lethal ventricular arrhythmias and heart failure in arrhythmogenic right ventricular cardiomyopathy: what are the differences between males and females? JACC Clin Electrophysiol. 2016. doi: 10.1016/j.jacep.2016.02.019.