Sex differences in the clinical presentation and natural history of dilated cardiomyopathy

Background Biological sex has a diverse impact on the cardiovascular system. Its influence on dilated cardiomyopathy (DCM) remains unresolved. Objectives This study aims to investigate sex-specific differences in DCM presentation, natural history, and prognostic factors. Methods We conducted a prospective observational cohort study of DCM patients assessing baseline characteristics, cardiac magnetic resonance imaging, biomarkers, and genotype. The composite outcome was cardiovascular mortality or major heart failure (HF) events. Results Overall, 206 females and 398 males with DCM were followed for a median of 3.9 years. At baseline, female patients had higher left ventricular ejection fraction, smaller left ventricular volumes, less prevalent mid-wall myocardial fibrosis (23% vs 42%), and lower high-sensitivity cardiac troponin I than males (all P < 0.05) with no difference in time from diagnosis, age at enrollment, N-terminal pro-B-type natriuretic peptide levels, pathogenic DCM genetic variants, myocardial fibrosis extent, or medications used for HF. Despite a more favorable profile, the risk of the primary outcome at 2 years was higher in females than males (8.6% vs 4.4%, adjusted HR: 3.14; 95% CI: 1.55-6.35; P = 0.001). Between 2 and 5 years, the effect of sex as a prognostic modifier attenuated. Age, mid-wall myocardial fibrosis, left ventricular ejection fraction, left atrial volume, N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin I, left bundle branch block, and NYHA functional class were not sex-specific prognostic factors. Conclusions We identify a novel paradox in prognosis for females with DCM. Female DCM patients have a paradoxical early increase in major HF events despite less prevalent myocardial fibrosis and a milder phenotype at presentation. Future studies should interrogate the mechanistic basis for these sex differences

Survival and quality of life of octogenarians who underwent mechanical valve replacement at a younger age

Purpose. Mechanical valve replacement is associated with complications, however, there is little information on the quality of life (QOL) of octogenarians who had undergone mechanical valve replacement at a relatively younger age. We examined survival, valve-related events, and the QOL of octogenarians who had undergone mechanical valve replacement. Methods. A total of 56 octogenarians who underwent mechanical valve replacement between 1969 and 1997 (age at the time of surgery, 65.6 ± 6.7 years), completed a questionnaire on survival, valve-related events, and QOL (basic activities of daily living, instrumental activities of daily living, mental health). Results. The mean follow-up was 12.4 ± 6.6 years, and the cumulative follow-up period was 642.4 patient-years. Six valve-related deaths (0.9%/patient-year) were registered during the follow-up. Furthermore, 11 valverelated events (1.8%/patient-year) were recorded. The mean age of the 21 survivors was 82.9 ± 1.8 years, and 19 of the survivors lived at home. Their QOL was excellent. Conclusion. The valve-related deaths and events in octogenarians who had previously undergone mechanical valve replacement at a younger age were within acceptable limits. The QOL was similar to that of octogenarians described in previous studies

A satisfação do usuário em hospital universitário User satisfaction at a university hospital

São apresentados resultados de uma pesquisa exploratória da satisfação/insatisfação de 158 pacientes que recorreram a um Hospital Universitário (HUPE) para consulta inicial. As entrevistas foram feitas por alunos do primeiro ano, como parte de projeto de inserção precoce do mesmo com a prática médica, acompanhando pacientes como observadores. Foi utilizado questionário que cobriu os vários aspectos do problema: variáveis sócio-demográficas, arte do cuidado, resolutividade da consulta médica, sugestões de melhoria dos serviços. Tanto alunos/observadores como os usuários conseguiram perceber com precisão os problemas do processo do atendimento (recepção, matrícula, consulta, enfermagem, serviço social, farmácia, exames complementares) mas houve divergência de opinião entre vários aspectos da satisfação/insatisfação entre alunos e usuários, provavelmente devido às origens sociais diferentes e expectativas diversas.<br>The results of a research project into the level of satisfaction/dissatisfaction of 158 first-time patients attending by an University hospital, Brazil, are presented. The interviews were carried out by first year medical students as part of a comprehensive project concerned with the restructuring of the Medical Curriculum. Its prime objective was to expose the students to patients/consumers as early as possible in their studies. After an introductory training program, the students asked the patients arriving at the hospital out-patient clinic for permission to observe them throughout the attendance given. A questionnaire was used which covered the various aspects of the consumers relationship with a medical institution (socio-economic variables, "art of care", outcome of the medical encounter and suggestions for improvement). Both patients and students were able to perceive the different problems that patients confront in the course of their dealings with a medical institution (reception, registration, nursing, social service and medical attention). The data showed a difference of opinion between students and patients regarding several aspects of the satisfaction/dissatisfaction items, partly because of their different social class status and parthy due to the different expectations regarding medical care