Ng Austin Chin Chwan, Wong Helen Siu Ping, Yong Andy Sze Chiang, Sindone Andrew Paul
Heart Failure Unit, Department of Cardiology, Concord RG Hospital, Hospital Road, Concord, NSW 2139 Australia.
Int J Cardiol. 2007 Apr 25;117(2):214-21. doi: 10.1016/j.ijcard.2006.04.079. Epub 2006 Oct 24.
Understanding the influence of gender in heart failure allows for better treatment. This study described the gender differences in heart failure patients and their response to therapy.
Consecutive patients (116 men vs. 52 women) from 1997 to 2002 were recruited from a single heart failure unit. Mean follow-up was 40+/-19 months.
Mean age was 68+/-12 years; left ventricular ejection fraction (LVEF) 27+/-12%. Women had higher mean LVEF, left ventricular end-diastolic diameter, and worse New York Heart Association (NYHA) functional class at baseline compared to men, while age, body mass index, blood pressure, estimated glomerular filtration rate and other co-morbidities did not differ significantly. Fewer women remained on angiotensin-converting-enzyme inhibitors while angiotensin-II-receptor blockers use increased significantly. By the end of the study, both genders exhibited similar magnitude of improvements in LVEF, cardiac dimensions, hemodynamics and mean NYHA functional class. In multivariate analysis, NYHA functional class was the strongest predictor of mortality: patients with NYHA class III/IV at baseline had 2.4-fold increased mortality risk compared to those in NYHA class I/II (95% CI 1.09-5.51, p=0.03). For men, functional class at baseline was the strongest predictor of mortality while for women, it was age at baseline.
In a contemporary tertiary referral heart failure clinic, women were observed to have better LVEF, but worse NYHA functional class than men. Both genders exhibited functional and hemodynamic improvements with only minor differences in their medical therapies. Predictors of mortality differed between the genders.
了解性别对心力衰竭的影响有助于更好地进行治疗。本研究描述了心力衰竭患者的性别差异及其对治疗的反应。
从一个单一的心力衰竭治疗单元招募了1997年至2002年的连续患者（116名男性和52名女性）。平均随访时间为40±19个月。
平均年龄为68±12岁；左心室射血分数（LVEF）为27±12%。与男性相比，女性在基线时的平均LVEF、左心室舒张末期直径更高，纽约心脏协会（NYHA）心功能分级更差，而年龄、体重指数、血压、估计肾小球滤过率和其他合并症无显著差异。继续使用血管紧张素转换酶抑制剂的女性较少，而血管紧张素II受体阻滞剂的使用显著增加。到研究结束时，两性在LVEF、心脏大小、血流动力学和平均NYHA心功能分级方面的改善程度相似。在多变量分析中，NYHA心功能分级是死亡率的最强预测因素：基线时NYHA III/IV级的患者与NYHA I/II级的患者相比，死亡风险增加2.4倍（95%CI 1.09-5.51，p=0.03）。对于男性，基线时的心功能分级是死亡率的最强预测因素，而对于女性，是基线时的年龄。
在当代三级转诊心力衰竭诊所中，观察到女性的LVEF较好，但NYHA心功能分级比男性差。两性在功能和血流动力学方面均有改善，药物治疗仅有微小差异。两性的死亡预测因素不同。
