Sex Differences in Dilated Cardiomyopathy: Evidence Gaps and Future Directions.

Evidence suggests that DCM is more prevalent in men, but whether this reflects biological differences or underdiagnosis in women remains uncertain.

有证据表明，DCM在男性中的患病率更高，但这是否反映了生物学差异或女性的诊断不足尚不明确。

This review explores the impact of sex on DCM, examining differences in epidemiology, etiology, clinical presentation, treatment response, and outcomes.

本综述探讨了性别对扩张型心肌病（DCM）的影响，检查了流行病学、病因学、临床表现、治疗反应和结果的差异。

Women often present with less severe cardiac phenotypes, including lower levels of fibrosis and better left ventricular function, yet the long-term prognosis of DCM in women is less clear.

女性通常表现出较不严重的心脏表型，包括较低的纤维化水平和更好的左心室功能，然而女性DCM的长期预后尚不明确。

Through a systematic reviewand meta-analysis, we found that male DCM patients with variants in PLN, DSP, and LMNA had higher arrhythmic event rates compared with TTNtv and BAG3 carriers.

通过系统综述和荟萃分析，我们发现男性DCM患者中携带PLN、DSP和LMNA基因变异者与携带TTNtv和BAG3变异者相比，心律失常事件发生率更高。

In female patients with DCM, those with RBM20, DSP, and PLN variants faced the highest arrhythmic risk, and TTNtv carriers the lowest.

在女性DCM患者中，携带RBM20、DSP和PLN基因变异者面临最高的心律失常风险，而携带TTNtv变异者风险最低。

PLN and LMNA variants had the highest heart failure risk in both sexes, whereas BAG3, RBM20, and TTN variants had lower heart failure rates in female compared with male carriers.

PLN和LMNA变异在两性中均具有最高的心力衰竭风险，而BAG3、RBM20和TTN变异在女性携带者中的心力衰竭率低于男性携带者。

These findings highlight the influence of sex and genotype on clinical outcomes.

这些发现强调了性别和基因型对临床结果的影响。

Current risk-stratification tools, such as those used for implantable cardioverter-defibrillators, may undertreat women owing to reliance on sex-neutral thresholds.

当前用于植入型心律转复除颤器的风险分层工具，例如，可能由于依赖性别中立的阈值而对女性治疗不足。

We highlight the role of genetic, environmental, and reproductive factors in shaping these disparities, including the influence of pregnancy, pregnancy complications, and menopause.

我们强调了遗传、环境和生殖因素在形成这些差异中的作用，包括怀孕、怀孕并发症和更年期的影响。

This review identifies key gaps in knowledge and calls for expanded representation of women in DCM studies and the development of sex-specific risk models.

本综述指出了知识中的关键空白，并呼吁在DCM研究中增加女性的代表性以及开发性别特异性的风险模型。

Addressing these gaps is essential to improving outcomes and advancing equitable personalized care for all DCM patients.

解决这些空白对于改善结果和推进所有DCM患者的公平个性化护理至关重要。