{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:24:25Z","timestamp":1790713465735,"version":"4.1.0"},"reference-count":129,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T00:00:00Z","timestamp":1621900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["AI145356"],"award-info":[{"award-number":["AI145356"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["AI152318"],"award-info":[{"award-number":["AI152318"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["AI154927"],"award-info":[{"award-number":["AI154927"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["20TPA35490415"],"award-info":[{"award-number":["20TPA35490415"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"name":"For Elysa Foundation","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/100009710","name":"Myocarditis Foundation","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100009710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Dilated cardiomyopathy (DCM) is characterized by dilatation of the left ventricle and impaired systolic function and is the second most common cause of heart failure after coronary heart disease. The etiology of DCM is diverse including genetic pathogenic variants, infection, inflammation, autoimmune diseases, exposure to chemicals\/toxins as well as endocrine and neuromuscular causes. DCM is inherited in 20\u201350% of cases where more than 30 genes have been implicated in the development of DCM with pathogenic variants in TTN (Titin) most frequently associated with disease. Even though male sex is a risk factor for heart failure, few studies have examined sex differences in the pathogenesis of DCM. We searched the literature for studies examining idiopathic or familial\/genetic DCM that reported data by sex in order to determine the sex ratio of disease. We found 31 studies that reported data by sex for non-genetic DCM with an average overall sex ratio of 2.5:1 male to female and 7 studies for familial\/genetic DCM with an overall average sex ratio of 1.7:1 male to female. No manuscripts that we found had more females than males in their studies. We describe basic and clinical research findings that may explain the increase in DCM in males over females based on sex differences in basic physiology and the immune and fibrotic response to damage caused by mutations, infections, chemotherapy agents and autoimmune responses.<\/jats:p>","DOI":"10.3390\/jcm10112289","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T13:14:21Z","timestamp":1621948461000},"page":"2289","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Sex Differences, Genetic and Environmental Influences on Dilated Cardiomyopathy"],"prefix":"10.3390","volume":"10","author":[{"given":"Angita","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Norton","sequence":"additional","affiliation":[{"name":"Department of Cancer Biology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8980-6059","authenticated-orcid":false,"given":"Katelyn A.","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1002-3313","authenticated-orcid":false,"suffix":"Jr.","given":"Leslie T.","family":"Cooper","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8515-744X","authenticated-orcid":false,"given":"Paldeep S.","family":"Atwal","sequence":"additional","affiliation":[{"name":"Genomic and Personalized Medicine, Atwal Clinic, 214 Brazilian Avenue, Suite 230, Palm Beach, FL 33480, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DeLisa","family":"Fairweather","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1038\/s41572-019-0084-1","article-title":"Dilated cardiomyopathy","volume":"5","author":"Schultheiss","year":"2019","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1038\/nrcardio.2013.105","article-title":"Dilated cardiomyopathy: The complexity of a diverse genetic architecture","volume":"10","author":"Hershberger","year":"2013","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/HCO.0b013e328337ba52","article-title":"The genetics of dilated cardiomyopathy","volume":"25","author":"Dellefave","year":"2010","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1038\/s41569-019-0284-0","article-title":"Genetics of dilated cardiomyopathy: Practical implications for heart failure management","volume":"17","author":"Rosenbaum","year":"2020","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1161\/CIRCGENETICS.111.961805","article-title":"Evaluating pathogenicity of rare variants from dilated cardiomyopathy in the exome era","volume":"5","author":"Norton","year":"2012","journal-title":"Circ. Cardiovasc. Genet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1016\/S1550-8579(07)80049-0","article-title":"Sexually dimorphic gene expression in mammalian somatic tissue","volume":"4","author":"Isensee","year":"2007","journal-title":"Gend. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00109-007-0240-z","article-title":"Sexually dimorphic gene expression in the heart of mice and men","volume":"86","author":"Isensee","year":"2008","journal-title":"J. Mol. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/S0195-668X(02)00823-0","article-title":"The EuroHeart Failure survey programme\u2014A survey on the quality of care among patients with heart failure in Europe. Part 1: Patient characteristics and diagnosis","volume":"24","author":"Cleland","year":"2003","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/S0008-6363(01)00510-7","article-title":"Gender-specific differences of cardiac remodeling in subjects with left ventricular dysfunction: A population-based study","volume":"53","author":"Luchner","year":"2002","journal-title":"Cardiovasc. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.jacc.2005.05.067","article-title":"Myocardial expression of fas and recovery of left ventricular function in patients with recent-onset cardiomyopathy","volume":"46","author":"Sheppard","year":"2005","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s11886-009-0077-x","article-title":"Cardiovascular magnetic resonance of myocarditis","volume":"12","author":"Cocker","year":"2010","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1136\/hrt.2008.164061","article-title":"Age and gender effects on the extent of myocardial involvement in acute myocarditis: A cardiovascular magnetic resonance study","volume":"95","author":"Cocker","year":"2009","journal-title":"Heart"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1152\/physrev.00021.2015","article-title":"Mechanistic Pathways of Sex Differences in Cardiovascular Disease","volume":"97","author":"Kararigas","year":"2017","journal-title":"Physiol. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.yjmcc.2004.11.013","article-title":"Estrogen receptor beta mediates gender differences in ischemia\/reperfusion injury","volume":"38","author":"Gabel","year":"2005","journal-title":"J. Mol. Cell Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"H469","DOI":"10.1152\/ajpheart.00723.2004","article-title":"Estrogen receptor-beta mediates male-female differences in the development of pressure overload hypertrophy","volume":"288","author":"Skavdahl","year":"2005","journal-title":"Am. J. Physiol Heart Circ. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Devanathan, S., Whitehead, T., Schweitzer, G.G., Fettig, N., Kovacs, A., Korach, K.S., Finck, B.N., and Shoghi, K.I. (2014). An animal model with a cardiomyocyte-specific deletion of estrogen receptor alpha: Functional, metabolic, and differential network analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0101900"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4362","DOI":"10.4049\/jimmunol.146.12.4362","article-title":"Estrogen regulates the IFN-gamma promoter","volume":"146","author":"Fox","year":"1991","journal-title":"J. Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Buskiewicz, I.A., Huber, S.A., and Fairweather, D. (2016). Sex hormone receptor expression in the immune system. Sex Differences in Physiology, Academic Press.","DOI":"10.1016\/B978-0-12-802388-4.00004-5"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3113","DOI":"10.1091\/mbc.10.10.3113","article-title":"Testosterone signaling through internalizable surface receptors in androgen receptor-free macrophages","volume":"10","author":"Benten","year":"1999","journal-title":"Mol. Biol. Cell"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1096\/fasebj.13.1.123","article-title":"Functional testosterone receptors in plasma membranes of T cells","volume":"13","author":"Benten","year":"1999","journal-title":"FASEB J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1085\/jgp.110.2.135","article-title":"Increased expression of the cardiac L-type calcium channel in estrogen receptor-deficient mice","volume":"110","author":"Johnson","year":"1997","journal-title":"J. Gen. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e579","DOI":"10.1161\/CIR.0000000000000455","article-title":"Current diagnostic and treatment strategies for specific dilated cardiomyopathies: A scientific statement from the American Heart Association","volume":"134","author":"Bozkurt","year":"2016","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13293-018-0176-8","article-title":"Sex differences in pulmonary arterial hypertension: Role of infection and autoimmunity in the pathogenesis of disease","volume":"9","author":"Batton","year":"2018","journal-title":"Biol. Sex. Differ."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13293-015-0037-7","article-title":"Sex differences in Sjogren\u2019s syndrome: A comprehensive review of immune mechanisms","volume":"6","author":"Brandt","year":"2015","journal-title":"Biol. Sex. Differ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ejheart.2007.12.012","article-title":"Gender related differences in patients presenting with acute heart failure. Results from EuroHeart Failure Survey II","volume":"10","author":"Nieminen","year":"2008","journal-title":"Eur J. Heart Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1161\/01.CIR.80.3.564","article-title":"Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy. A population-based study in Olmsted County, Minnesota, 1975\u20131984","volume":"80","author":"Codd","year":"1989","journal-title":"Circulation"},{"key":"ref_27","first-page":"357","article-title":"Carditis in poliomyelitis; an anatomic study of 35 cases and review of the literature","volume":"25","author":"Ludden","year":"1949","journal-title":"Am. J. Pathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/00005792-196803000-00003","article-title":"Adult heart disease due to the Coxsackie virus B infection","volume":"47","author":"Sainani","year":"1968","journal-title":"Medicine"},{"key":"ref_29","first-page":"425","article-title":"Viral myocarditis. A review","volume":"101","author":"Woodruff","year":"1980","journal-title":"Am. J. Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1136\/hrt.52.3.327","article-title":"Cardiomyopathy in western Denmark","volume":"52","author":"Bagger","year":"1984","journal-title":"Br. Heart J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1136\/hrt.57.6.521","article-title":"The course of idiopathic dilated cardiomyopathy in New Zealand","volume":"57","author":"Ikram","year":"1987","journal-title":"Br. Heart J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1093\/oxfordjournals.eurheartj.a059803","article-title":"Factors predicting mortality in idiopathic dilated cardiomyopathy","volume":"11","author":"Komajda","year":"1990","journal-title":"Eur. Heart J."},{"key":"ref_33","first-page":"1077","article-title":"Clinical and prognostic significance of echocardiographic parameters in dilated cardiomyopathy: A prospective study on 225 patients. The Italian Multicenter Study of Cardiomyopathies Group","volume":"22","author":"Sachero","year":"1992","journal-title":"G. Ital. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/0002-9149(93)90355-G","article-title":"Comparison of clinical findings in idiopathic dilated cardiomyopathy in women versus men. The Italian Multicenter Cardiomyopathy Study Group (SPIC)","volume":"72","author":"Gavazzi","year":"1993","journal-title":"Am. J. Cardiol."},{"key":"ref_35","first-page":"583","article-title":"Black-white differences in mortality in idiopathic dilated cardiomyopathy: The Washington, DC, dilated cardiomyopathy study","volume":"86","author":"Coughlin","year":"1994","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_36","first-page":"1109","article-title":"Dilated cardiomyopathy: A new natural history? The experience of the Italian Multicenter Cardiomyopathy Study (SPIC)","volume":"25","author":"Gavazzi","year":"1995","journal-title":"G. Ital. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S1071-9164(96)80026-1","article-title":"Determinants of prognosis in nonischemic dilated cardiomyopathy","volume":"2","author":"Grzybowski","year":"1996","journal-title":"J. Card. Fail."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/S0002-9149(99)00821-8","article-title":"Long-term prognostic value of time domain analysis of signal-averaged electrocardiography in idiopathic dilated cardiomyopathy","volume":"85","author":"Fauchier","year":"2000","journal-title":"Am. J. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1056\/NEJMoa033088","article-title":"Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy","volume":"350","author":"Kadish","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1038\/labinvest.3700031","article-title":"Toll-like receptor 4 is expressed with enteroviral replication in myocardium from patients with dilated cardiomyopathy","volume":"84","author":"Satoh","year":"2004","journal-title":"Lab. Investig."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jjcc.2008.06.001","article-title":"Improvement in prognosis of dilated cardiomyopathy in the elderly over the past 20 years","volume":"52","author":"Kubo","year":"2008","journal-title":"J. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1093\/eurheartj\/ehp549","article-title":"The gene expression profile of patients with new-onset heart failure reveals important gender-specific differences","volume":"31","author":"Heidecker","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"E24","DOI":"10.1002\/clc.20533","article-title":"Clinical features of the dilated phase of hypertrophic cardiomyopathy in comparison with those of dilated cardiomyopathy","volume":"33","author":"Hamada","year":"2010","journal-title":"Clin. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.jacc.2011.05.033","article-title":"Clinical and demographic predictors of outcomes in recent onset dilated cardiomyopathy: Results of the IMAC (Intervention in Myocarditis and Acute Cardiomyopathy)-2 study","volume":"58","author":"McNamara","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Du, Y., Yan, L., Wang, J., Zhan, W., Song, K., Han, X., Li, X., Cao, J., and Liu, H. (2012). \u03b21-Adrenoceptor autoantibodies from DCM patients enhance the proliferation of T lymphocytes through the \u03b21-AR\/cAMP\/PKA and p38 MAPK pathways. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0052911"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1161\/CIRCHEARTFAILURE.112.000120","article-title":"Improving survival rates of patients with idiopathic dilated cardiomyopathy in Tuscany over 3 decades: Impact of evidence-based management","volume":"6","author":"Castelli","year":"2013","journal-title":"Circ. Heart Fail."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1002\/clc.22193","article-title":"The genetics of dilated cardiomyopathy: A prioritized candidate gene study of LMNA, TNNT2, TCAP, and PLN","volume":"36","author":"Desbiens","year":"2013","journal-title":"Clin. Cardiol."},{"key":"ref_48","first-page":"76","article-title":"The natural history of acute dilated cardiomyopathy","volume":"125","author":"Dec","year":"2014","journal-title":"Trans. Am. Clin. Clim. Assoc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1002\/ejhf.16","article-title":"Long-term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: Changing mortality over the last 30 years","volume":"16","author":"Merlo","year":"2014","journal-title":"Eur. J. Heart Fail."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.jacc.2015.07.023","article-title":"Prognostic Relevance of Gene-Environment Interactions in Patients with Dilated Cardiomyopathy: Applying the MOGE(S) Classification","volume":"66","author":"Hazebroek","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1093\/eurheartj\/ehu301","article-title":"Atlas of the clinical genetics of human dilated cardiomyopathy","volume":"36","author":"Haas","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.healun.2015.12.002","article-title":"Familial dilated cardiomyopathy diagnosis is commonly overlooked at the time of transplant listing","volume":"35","author":"Seidelmann","year":"2016","journal-title":"J. Heart Lung Transpl."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1002\/ejhf.1216","article-title":"Sex\u2014And age-based differences in the natural history and outcome of dilated cardiomyopathy","volume":"20","author":"Halliday","year":"2018","journal-title":"Eur. J. Heart Fail."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2422","DOI":"10.1111\/jcmm.13540","article-title":"GDF-15 is a better complimentary marker for risk stratification of arrhythmic death in non-ischaemic, dilated cardiomyopathy than soluble ST2","volume":"22","author":"Stojkovic","year":"2018","journal-title":"J. Cell Mol. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1093\/eurheartj\/ehx819","article-title":"The Cardiomyopathy Registry of the EURObservational Research Programme of the European Society of Cardiology: Baseline data and contemporary management of adult patients with cardiomyopathies","volume":"39","author":"Charron","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_56","first-page":"61","article-title":"Electrocardiogram signs of right ventricular hypertrophy may help identify pulmonary hypertension in patients with dilated cardiomyopathy","volume":"22","author":"Chen","year":"2019","journal-title":"Int J. Cardiol. Heart Vasc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1056\/NEJM200012073432304","article-title":"Mutations in sarcomere protein genes as a cause of dilated cardiomyopathy","volume":"343","author":"Kamisago","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.jacc.2009.11.017","article-title":"Familial dilated cardiomyopathy caused by an alpha-tropomyosin mutation: The distinctive natural history of sarcomeric dilated cardiomyopathy","volume":"55","author":"Lakdawala","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"De Denus, S., Mottet, F., Korol, S., Feroz Zada, Y., Provost, S., Mongrain, I., Asselin, G., Oussaid, E., Busseuil, D., and Lettre, G. (2020). A genetic association study of heart failure: More evidence for the role of BAG3 in idiopathic dilated cardiomyopathy. Esc Heart Fail.","DOI":"10.1002\/ehf2.12934"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.cpcardiol.2012.07.003","article-title":"Sex and gender differences in myocarditis and dilated cardiomyopathy","volume":"38","author":"Fairweather","year":"2013","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1056\/NEJMoa1110186","article-title":"Truncations of titin causing dilated cardiomyopathy","volume":"366","author":"Herman","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1038\/gim.2013.204","article-title":"The landscape of genetic variation in dilated cardiomyopathy as surveyed by clinical DNA sequencing","volume":"16","author":"Pugh","year":"2014","journal-title":"Genet. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1172\/JCI62862","article-title":"Genetic mutations and mechanisms in dilated cardiomyopathy","volume":"123","author":"McNally","year":"2013","journal-title":"J. Clin. Investig."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1016\/j.jacc.2017.01.043","article-title":"Autosomal Recessive Cardiomyopathy Presenting as Acute Myocarditis","volume":"69","author":"Belkaya","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s00430-003-0189-7","article-title":"Dystrophin disruption in enterovirus-induced myocarditis and dilated cardiomyopathy: From bench to bedside","volume":"193","author":"Badorff","year":"2004","journal-title":"Med. Microbiol. Immunol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.jacc.2011.01.072","article-title":"Diagnostic work-up and risk stratification in X-linked dilated cardiomyopathies caused by dystrophin defects","volume":"58","author":"Diegoli","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_67","first-page":"11","article-title":"Autoimmune myocarditis, valvulitis, and cardiomyopathy","volume":"14","author":"Myers","year":"2013","journal-title":"Curr. Protoc. Immunol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Myers, J.M., Cooper, L.T., Kem, D.C., Stavrakis, S., Kosanke, S.D., Shevach, E.M., Fairweather, D., Stoner, J.A., Cox, C.J., and Cunningham, M.W. (2016). Cardiac myosin-Th17 responses promote heart failure in human myocarditis. JCI Insight, 1.","DOI":"10.1172\/jci.insight.85851"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e008968","DOI":"10.1161\/JAHA.118.008968","article-title":"Elevated Sera sST2 Is Associated with Heart Failure in Men \u226450 Years Old with Myocarditis","volume":"8","author":"Coronado","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1161\/CIRCULATIONAHA.108.769489","article-title":"Predictors of outcome in patients with suspected myocarditis","volume":"118","author":"Kindermann","year":"2008","journal-title":"Circulation"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1056\/NEJM199912023412302","article-title":"Missense mutations in the rod domain of the lamin A\/C gene as causes of dilated cardiomyopathy and conduction-system disease","volume":"341","author":"Fatkin","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.ajhg.2011.01.016","article-title":"Genome-wide studies of copy number variation and exome sequencing identify rare variants in BAG3 as a cause of dilated cardiomyopathy","volume":"88","author":"Norton","year":"2011","journal-title":"Am. J. Hum. Genet."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1002\/humu.21603","article-title":"Dilated cardiomyopathy-associated BAG3 mutations impair Z-disc assembly and enhance sensitivity to apoptosis in cardiomyocytes","volume":"32","author":"Arimura","year":"2011","journal-title":"Hum. Mutat."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1093\/cvr\/cvm015","article-title":"Mutations in the Z-band protein myopalladin gene and idiopathic dilated cardiomyopathy","volume":"77","author":"Xu","year":"2008","journal-title":"Cardiovasc. Res."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1136\/hrt.2011.227967","article-title":"Desmosomal protein gene mutations in patients with idiopathic dilated cardiomyopathy undergoing cardiac transplantation: A clinicopathological study","volume":"97","author":"Syrris","year":"2011","journal-title":"Heart"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jacbts.2016.05.004","article-title":"FLNC gene splice mutations cause dilated cardiomyopathy","volume":"1","author":"Begay","year":"2016","journal-title":"JACC Basic Transl. Sci."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/j.jacc.2009.05.038","article-title":"Mutations in ribonucleic acid binding protein gene cause familial dilated cardiomyopathy","volume":"54","author":"Brauch","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1161\/01.CIR.0000144458.58660.BB","article-title":"SCN5A mutation associated with dilated cardiomyopathy, conduction disorder, and arrhythmia","volume":"110","author":"McNair","year":"2004","journal-title":"Circulation"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1001\/jama.293.4.447","article-title":"Sodium channel mutations and susceptibility to heart failure and atrial fibrillation","volume":"293","author":"Olson","year":"2005","journal-title":"JAMA"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1006\/jmcc.2000.1339","article-title":"Mutations that alter the surface charge of alpha-tropomyosin are associated with dilated cardiomyopathy","volume":"33","author":"Olson","year":"2001","journal-title":"J. Mol. Cell. Cardiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1097\/GIM.0b013e3181f2481f","article-title":"Clinical and genetic issues in dilated cardiomyopathy: A review for genetics professionals","volume":"12","author":"Hershberger","year":"2010","journal-title":"Genet. Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s00439-011-1081-y","article-title":"Sex differences in disease risk from reported genome-wide association study findings","volume":"131","author":"Liu","year":"2012","journal-title":"Hum. Genet."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1152\/physiolgenomics.00265.2007","article-title":"Human cardiac-specific cDNA array for idiopathic dilated cardiomyopathy: Sex-related differences","volume":"33","author":"Haddad","year":"2008","journal-title":"Physiol. Genom."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.ymgme.2004.04.013","article-title":"Novel troponin T mutation in familial dilated cardiomyopathy with gender-dependant severity","volume":"83","author":"Stefanelli","year":"2004","journal-title":"Mol. Genet. Metab."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/S0735-1097(99)00276-4","article-title":"Clinical profiles of four large pedigrees with familial dilated cardiomyopathy: Preliminary recommendations for clinical practice","volume":"34","author":"Crispell","year":"1999","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.cardfail.2006.03.009","article-title":"Clinical characteristics of 304 kindreds evaluated for familial dilated cardiomyopathy","volume":"12","author":"Kushner","year":"2006","journal-title":"J. Card Fail."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1093\/eurjhf\/hft013","article-title":"Genetic analysis in 418 index patients with idiopathic dilated cardiomyopathy: Overview of 10 years\u2019 experience","volume":"15","author":"Post","year":"2013","journal-title":"Eur. J. Heart Fail."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Franaszczyk, M., Chmielewski, P., Truszkowska, G., Stawinski, P., Michalak, E., Rydzanicz, M., Sobieszczanska-Malek, M., Pollak, A., Szczygie\u0142, J., and Kosinska, J. (2017). Titin truncating variants in dilated cardiomyopathy\u2014Prevalence and genotype-phenotype correlations. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0169007"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1002\/ejhf.15","article-title":"Sex differences in cardiomyopathies","volume":"16","author":"Meyer","year":"2014","journal-title":"Eur. J. Heart Fail."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.ijcard.2018.10.091","article-title":"Sex-related differences in cardiomyopathies","volume":"286","author":"Pelliccia","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1161\/01.CIR.93.5.841","article-title":"Report of the 1995 World Health Organization\/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies","volume":"93","author":"Richardson","year":"1996","journal-title":"Circulation"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1093\/eurjhf\/hfr014","article-title":"Expression of functional T-cell markers and T-cell receptor Vbeta repertoire in endomyocardial biopsies from patients presenting with acute myocarditis and dilated cardiomyopathy","volume":"13","author":"Noutsias","year":"2011","journal-title":"Eur. J. Heart Fail."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"e007405","DOI":"10.1161\/CIRCHEARTFAILURE.120.007405","article-title":"Management of acute myocarditis and chronic inflammatory cardiomyopathy: An expert consensus document","volume":"13","author":"Ammirati","year":"2020","journal-title":"Circ. Heart Fail."},{"key":"ref_94","unstructured":"Kang, M., and An, J. (2021). Viral myocarditis. StatPearls, StatPearls Publishing."},{"key":"ref_95","unstructured":"Nguyen, T., and Waseem, M. (2021). Chagas disease. StatPearls, StatPearls Publishing."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1038\/90686","article-title":"Contribution of the innate immune system to autoimmune myocarditis: A role for complement","volume":"2","author":"Kaya","year":"2001","journal-title":"Nat. Immunol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"3516","DOI":"10.4049\/jimmunol.176.6.3516","article-title":"Complement receptor 1 and 2 deficiency increases coxsackievirus B3-induced myocarditis, dilated cardiomyopathy, and heart failure by increasing macrophages, IL-1beta, and immune complex deposition in the heart","volume":"176","author":"Fairweather","year":"2006","journal-title":"J. Immunol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.hfc.2009.08.012","article-title":"Genomic and proteomic analysis of myocarditis and dilated cardiomyopathy","volume":"6","author":"Cooper","year":"2010","journal-title":"Heart Fail. Clin."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"4731","DOI":"10.4049\/jimmunol.170.9.4731","article-title":"IL-12 receptor beta 1 and Toll-like receptor 4 increase IL-1 beta- and IL-18-associated myocarditis and coxsackievirus replication","volume":"170","author":"Fairweather","year":"2003","journal-title":"J. Immunol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"6710","DOI":"10.4049\/jimmunol.178.11.6710","article-title":"Cutting edge: Cross-regulation by TLR4 and T cell Ig mucin-3 determines sex differences in inflammatory heart disease","volume":"178","author":"Davis","year":"2007","journal-title":"J. Immunol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"H1726","DOI":"10.1152\/ajpheart.00783.2011","article-title":"Testosterone and interleukin-1\u03b2 increase cardiac remodeling during coxsackievirus B3 myocarditis via serpin A 3n","volume":"302","author":"Coronado","year":"2012","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1016\/S0002-9440(10)63241-5","article-title":"Interferon-gamma protects against chronic viral myocarditis by reducing mast cell degranulation, fibrosis, and the profibrotic cytokines transforming growth factor-beta 1, interleukin-1 beta, and interleukin-4 in the heart","volume":"165","author":"Fairweather","year":"2004","journal-title":"Am. J. Pathol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"261","DOI":"10.4049\/jimmunol.174.1.261","article-title":"IL-12 protects against coxsackievirus B3-induced myocarditis by increasing IFN-gamma and macrophage and neutrophil populations in the heart","volume":"174","author":"Fairweather","year":"2005","journal-title":"J. Immunol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"129486","DOI":"10.1155\/2012\/129486","article-title":"Th2 regulation of viral myocarditis in mice: Different roles for TLR3 versus TRIF in progression to chronic disease","volume":"2012","author":"Abston","year":"2012","journal-title":"Clin. Dev. Immunol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"R267","DOI":"10.1152\/ajpregu.00516.2011","article-title":"TLR3 deficiency induces chronic inflammatory cardiomyopathy in resistant mice following coxsackievirus B3 infection: Role for IL-4","volume":"304","author":"Abston","year":"2013","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S0002-9440(10)61685-9","article-title":"Experimental autoimmune myocarditis in A\/J mice is an interleukin-4-dependent disease with a Th2 phenotype","volume":"159","author":"Afanasyeva","year":"2001","journal-title":"Am. J. Pathol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1084\/jem.20161702","article-title":"Eosinophil-derived IL-4 drives progression of myocarditis to inflammatory dilated cardiomyopathy","volume":"214","author":"Diny","year":"2017","journal-title":"J. Exp. Med."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1084\/jem.20132126","article-title":"Cardiac fibroblasts mediate IL-17A-driven inflammatory dilated cardiomyopathy","volume":"211","author":"Wu","year":"2014","journal-title":"J. Exp. Med."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1161\/CIRCHEARTFAILURE.111.963769","article-title":"IL-33 independently induces eosinophilic pericarditis and cardiac dilation: ST2 improves cardiac function","volume":"5","author":"Abston","year":"2012","journal-title":"Circ. Heart Fail."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1586\/eci.12.10","article-title":"Autoimmune heart disease: Role of sex hormones and autoantibodies in disease pathogenesis","volume":"8","author":"Fairweather","year":"2012","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1080\/0891693042000196200","article-title":"Mast cells and innate cytokines are associated with susceptibility to autoimmune heart disease following coxsackievirus B3 infection","volume":"37","author":"Fairweather","year":"2004","journal-title":"Autoimmunity"},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"Tschope, C., Muller, I., Xia, Y., Savvatis, K., Pappritz, K., Pinkert, S., Lassner, D., Heimesaat, M.M., Spillmann, F., and Miteva, K. (2017). NOD2 (Nucleotide-Binding Oligomerization Domain 2) is a major pathogenic mediator of coxsackievirus B3-Induced myocarditis. Circ. Heart Fail., 10.","DOI":"10.1161\/CIRCHEARTFAILURE.117.003870"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"2276","DOI":"10.1161\/CIRCULATIONAHA.105.536433","article-title":"Myeloid differentiation factor-88 plays a crucial role in the pathogenesis of Coxsackievirus B3-induced myocarditis and influences type I interferon production","volume":"112","author":"Fuse","year":"2005","journal-title":"Circulation"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1038\/nri3800","article-title":"Role of innate and adaptive immune mechanisms in cardiac injury and repair","volume":"15","author":"Epelman","year":"2015","journal-title":"Nat. Rev. Immunol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21654","article-title":"Cancer statistics, 2021","volume":"71","author":"Siegel","year":"2021","journal-title":"Ca Cancer J. Clin."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1161\/CIRCULATIONAHA.114.013777","article-title":"Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy","volume":"131","author":"Cardinale","year":"2015","journal-title":"Circulation"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1179546819866445","DOI":"10.1177\/1179546819866445","article-title":"Cancer therapy-related cardiac dysfunction: An overview for the clinician","volume":"13","author":"Perez","year":"2019","journal-title":"Clin. Med. Insights Cardiol."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1038\/nm.2919","article-title":"Identification of the molecular basis of doxorubicin-induced cardiotoxicity","volume":"18","author":"Zhang","year":"2012","journal-title":"Nat. Med."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"101482","DOI":"10.1016\/j.redox.2020.101482","article-title":"Sex differences in inflammation, redox biology, mitochondria and autoimmunity","volume":"31","author":"Sin","year":"2020","journal-title":"Redox Biol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"e002892","DOI":"10.1161\/CIRCGEN.119.002892","article-title":"SOS1 Gain-of-Function Variants in Dilated Cardiomyopathy","volume":"13","author":"Cowan","year":"2020","journal-title":"Circ. Genom. Precis. Med."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1249\/00005768-199509000-00004","article-title":"Cardiovascular effects of androgenic-anabolic steroids","volume":"27","author":"Melchert","year":"1995","journal-title":"Med. Sci Sports Exerc"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1161\/01.RES.61.1.12","article-title":"Effects of gonadectomy and hormonal replacement on rat hearts","volume":"61","author":"Scheuer","year":"1987","journal-title":"Circ. Res."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1038\/nrcardio.2009.105","article-title":"Gender differences in the cardiovascular effect of sex hormones","volume":"6","author":"Vitale","year":"2009","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.4049\/jimmunol.0902383","article-title":"17Beta-estradiol promotes TLR4-triggered proinflammatory mediator production through direct estrogen receptor alpha signaling in macrophages in vivo","volume":"185","author":"Calippe","year":"2010","journal-title":"J. Immunol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00395-019-0719-0","article-title":"Blocking the IL-1beta signalling pathway prevents chronic viral myocarditis and cardiac remodeling","volume":"114","author":"Kraft","year":"2019","journal-title":"Basic Res. Cardiol."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/j.cardiores.2005.11.031","article-title":"Estrogen improves cardiac recovery after ischemia\/reperfusion by decreasing tumor necrosis factor-alpha","volume":"69","author":"Xu","year":"2006","journal-title":"Cardiovasc. Res."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1152\/physiolgenomics.00199.2010","article-title":"Role of the estrogen\/estrogen-receptor-beta axis in the genomic response to pressure overload-induced hypertrophy","volume":"43","author":"Kararigas","year":"2011","journal-title":"Physiol. Genom."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"17464","DOI":"10.1074\/jbc.M414220200","article-title":"Nuclear factor-kappaB activation leads to down-regulation of fatty acid oxidation during cardiac hypertrophy","volume":"280","author":"Planavila","year":"2005","journal-title":"J. Biol. Chem."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1200\/JCO.2011.34.8987","article-title":"Anthracycline-related cardiomyopathy after childhood cancer: Role of polymorphisms in carbonyl reductase genes\u2014A report from the Children\u2019s Oncology Group","volume":"30","author":"Blanco","year":"2012","journal-title":"J. Clin. Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/11\/2289\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:07:20Z","timestamp":1760162840000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/11\/2289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,25]]},"references-count":129,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["jcm10112289"],"URL":"https:\/\/doi.org\/10.3390\/jcm10112289","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,25]]}}}