{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:38:09Z","timestamp":1790217489114,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Dilated cardiomyopathy (DCM) is a genetically heterogeneous disease, presenting diverse clinical phenotypes and outcomes based on the underlying gene affected. The influence of sex on the gene-specific long-term prognosis of patients with genetic DCM remains unclear. This study aims to determine the effect of sex on the long-term prognosis per underlying genogroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study was conducted using data from 4 international referral centers. Baseline and longitudinal clinical data of patients with DCM, with a median follow-up of 6.7 years (interquartile range, 3.5\u201311.9 years), were collected. The study included men and women with DCM who had undergone genetic testing. Patients were categorized into 7 genotype groups: cytoskeletal\/Z-disk, desmosomal, nuclear envelope, motor sarcomeric,\n                      <jats:italic toggle=\"yes\">TTN<\/jats:italic>\n                      , other genetic, and genotype negative. The main outcomes measured were left ventricular reverse remodeling, mortality, heart failure hospitalization, heart transplantation, and malignant ventricular arrhythmias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 1716 patients, 1130 (66%) were men and 510 (30%) had a (likely) pathogenic variant. Ventricular remodeling was gene-dependent in women, with TTN patients exhibiting the highest rate (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.003) and desmosomal patients the lowest (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.04) compared with the genotype-negative group. After a median follow-up of 6.7 years, 334 men (29%) and 140 women (24%) reached the primary end point. Men with a (likely) pathogenic variant had the poorest prognosis, showing a higher rate of major adverse events (adjusted hazard ratio, 1.48 [95% CI, 1.12\u20131.95];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.02) and malignant ventricular arrhythmias (adjusted hazard ratio, 1.83 [95% CI, 1.16\u20132.88];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.009) compared with genotype-negative women. Prognosis varied by gene in men (log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001) but not in women (log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.1). The cytoskeletal\/Z-disk, desmosomal, and nuclear envelope groups had the worst prognosis in men.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The genetic architecture and sex are critical predictors of left ventricular reverse remodeling and long-term prognosis in DCM. These factors should be integrated into individualized risk prediction models to enhance clinical outcomes in patients with DCM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.124.012592","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T09:01:26Z","timestamp":1758704486000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Sex Differences in Prognosis of Patients With Genetic Dilated Cardiomyopathy"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0965-6359","authenticated-orcid":true,"given":"Sophie L.V.M.","family":"Stroeks","sequence":"first","affiliation":[{"name":"Department of Cardiology, Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands (S.L.V.M.S., M.A.S., R.E.W.v.L., M.T.H.M.H., A.G.R., M.F.H., E.A.V.J., S.R.B.H., J.A.J.V.)."},{"name":"KU Leuven, Cardiovascular Sciences, Belgium (S.L.V.M.S., E.A.V.J., S.R.B.H.)."},{"name":"Department of Clinical Genetics, Maastricht University Medical Center, the Netherlands (S.L.V.M.S., P.W., D.M.E.I.H., I.P.C.K., A.v.d.W., M.F.H., M.N., H.G.B., J.A.J.V.)."},{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1022-3131","authenticated-orcid":true,"given":"Marco","family":"Merlo","sequence":"additional","affiliation":[{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."},{"name":"Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste ASUITS, Italy (M.M., A.C., M.D.F., M.S., C.P.L.D.G., M.I., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2127-5287","authenticated-orcid":true,"given":"Nerea","family":"Mora-Ayestaran","sequence":"additional","affiliation":[{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."},{"name":"Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain (N.M.-A., B.P., E.G.-L., F.D., 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Netherlands (S.L.V.M.S., M.A.S., R.E.W.v.L., M.T.H.M.H., A.G.R., M.F.H., E.A.V.J., S.R.B.H., J.A.J.V.)."},{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2310-0448","authenticated-orcid":true,"given":"Matteo","family":"Dal Ferro","sequence":"additional","affiliation":[{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."},{"name":"Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste ASUITS, Italy (M.M., A.C., M.D.F., M.S., C.P.L.D.G., M.I., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9081-7003","authenticated-orcid":true,"given":"Belen","family":"Peiro","sequence":"additional","affiliation":[{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."},{"name":"Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain (N.M.-A., B.P., E.G.-L., F.D., 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M.S., C.P.L.D.G., M.I., G.S.)."},{"name":"University of Verona, Section of Cardiology, Italy (M.S., J.P.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4175-1487","authenticated-orcid":true,"given":"Esther","family":"Gonzalez-Lopez","sequence":"additional","affiliation":[{"name":"Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain (N.M.-A., B.P., E.G.-L., F.D., P.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0080-2893","authenticated-orcid":true,"given":"Ingrid P.C.","family":"Krapels","sequence":"additional","affiliation":[{"name":"Department of Clinical Genetics, Maastricht University Medical Center, the Netherlands (S.L.V.M.S., P.W., D.M.E.I.H., I.P.C.K., A.v.d.W., M.F.H., M.N., H.G.B., J.A.J.V.)."},{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2690-5169","authenticated-orcid":true,"given":"Carola","family":"Pio Loco Detto Gava","sequence":"additional","affiliation":[{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."},{"name":"Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste ASUITS, Italy (M.M., A.C., M.D.F., M.S., C.P.L.D.G., M.I., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"van den Wijngaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Genetics, Maastricht University Medical Center, the Netherlands (S.L.V.M.S., P.W., D.M.E.I.H., I.P.C.K., A.v.d.W., M.F.H., M.N., H.G.B., J.A.J.V.)."},{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6222-071X","authenticated-orcid":true,"given":"Michiel T.H.M.","family":"Henkens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands (S.L.V.M.S., M.A.S., R.E.W.v.L., M.T.H.M.H., A.G.R., M.F.H., E.A.V.J., S.R.B.H., J.A.J.V.)."},{"name":"Department of Pathology, Maastricht University Medical Centre, the Netherlands (M.T.H.M.H.)."},{"name":"Netherlands Heart Institute (NLHI), Utrecht, the Netherlands (M.T.H.M.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9721-9755","authenticated-orcid":true,"given":"Manuela","family":"Iseppi","sequence":"additional","affiliation":[{"name":"Members of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart) (S.L.V.M.S., M.M., N.M.-A., P.W., A.C., M.A.S., M.D.F., B.P., D.M.E.I.H., M.S., I.P.C.K., C.P.L.D.G., A.v.d.W., M.I., V.P.M.v.E., H.G.B., F.D., G.S., P.G.-P., J.A.J.V.)."},{"name":"Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste ASUITS, Italy (M.M., A.C., M.D.F., M.S., C.P.L.D.G., M.I., G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9228-8045","authenticated-orcid":true,"given":"Anne G.","family":"Raafs","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands (S.L.V.M.S., M.A.S., R.E.W.v.L., M.T.H.M.H., A.G.R., M.F.H., E.A.V.J., S.R.B.H., J.A.J.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0234-438X","authenticated-orcid":true,"given":"Martijn F.","family":"Hoes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands (S.L.V.M.S., M.A.S., R.E.W.v.L., M.T.H.M.H., A.G.R., M.F.H., E.A.V.J., S.R.B.H., J.A.J.V.)."},{"name":"Department of Clinical Genetics, Maastricht University Medical Center, the Netherlands (S.L.V.M.S., P.W., D.M.E.I.H., I.P.C.K., A.v.d.W., M.F.H., M.N., H.G.B., 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