Sex and gender differences in characteristics, treatment, and short-term prognosis among patients with acute myocarditis in Korea

초록

The Understanding and interest in sex and gender differences in acute myocarditis (AM) have gradually increased. The sex and gender differences in AM within Asian populations may exhibit some unique trends, influenced by genetic, environmental, and cultural factors specific to the region. This study aimed to demonstrate the sex and gender differences in clinical characteristics, treatments and short-term prognosis of admission of AM in Korea. Methods & results We analyzed the data collected retrospectively from 7 tertiary hospitals in Korea in the years 2004-2022. Overall, 841 patients with biopsy-proven or clinically suspected acute myocarditis were included. The number of men was larger than women (495[58.9%] and 346[41.1%], respectively). Women were older than men (38.4 ± 19.8 vs. 34.5 ± 19.9, P = 0.005). Women had a higher incidence of fulminant myocarditis (66.2% vs 53.1%) and a higher SOFA score (6.1 ± 5.9 vs 4.7 ± 5.4). The symptoms of AM were similar across genders. Diagnostic tests showed that men more frequently presented with ST elevation on ECG (31.0% vs 22.8%, P = 0.003), whereas women had a higher prevalence of ventricular tachycardia or fibrillation (15.0% vs 9.1%, P = 0.009). Peak levels of natriuretic peptides and lactic acid were higher in women (mean NT pro BNP: 13,394 vs 9095 pg/mL, P < 0.001, mean lactic acid: 5.47 vs 4.24 mmol/L, P = 0.05). Women had lower LVEF (40.9 ± 19.3 vs 45.5 ± 16.9%, P = 0.001) and were more likely to present right ventricular dysfunction (27.8% vs 19.7%, P = 0.008) and pericardial effusion (54.4% vs 43.7%, P = 0.003). In patients who underwent CMR (n = 269), the frequency of LGE was not different between the sexes, but myocardial edema was more commonly observed in women (52.3% vs 36.4%, P = 0.012). Regarding treatment, there was no gender difference in the use of immunosuppressants (37.9% vs 35.2%, P = 0.424), but women had a higher rate of use of vasopressors and inotropic (56.9% vs 41.2%, P < 0.001), extracorporeal membrane oxygenation insertion (34.1% vs 20.0% P < 0.001) and receiving heart transplantation (6.1% vs 2.8%, P = 0.023). In the prognosis, in-hospital mortality and mortality during follow-up (mean 947 days) were not different between men and women (13.6% vs 9.7%, P = 0.096 and 12.8% vs 11.1%, P = 0.514, respectively). However, the readmission rate was higher in women than in men (15.3% vs 8.7%, P = 0.004). Although most patients recovered LVEF at discharge (86%), the proportion of patients with less than 40% LVEF at discharge was higher in women (17.6% vs 11.4%, P = 0.04)