Kajimoto Katsuya, Minami Yuichiro, Sato Naoki, Otsubo Shigeru, Kasanuki Hiroshi
Division of Cardiology, Sekikawa Hospital, Tokyo, Japan.
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Am J Cardiol. 2017 Aug 1;120(3):435-442. doi: 10.1016/j.amjcard.2017.04.043. Epub 2017 May 11.
In patients with acute decompensated heart failure (HF), the influence of gender on anemia, left ventricular ejection fraction (EF), and outcomes is unclear. We evaluated the association of anemia and left ventricular EF with survival in men or women hospitalized for acute decompensated HF. Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry, 4,215 patients (2,450 men and 1,765 women) discharged alive after hospitalization for acute decompensated HF were enrolled to evaluate the association of gender, anemia (hemoglobin <13.0 g/dl for men and <12.0 g/dl for women) at discharge, and a preserved or reduced EF with all-cause death or cardiac death after discharge. Men or women were divided into 4 groups based on left ventricular EF (preserved or reduced EF) and anemia status at discharge. The median follow-up period after discharge was 524 days (384 to 791). After adjustment for multiple co-morbidities, there was no adverse influence of anemia in men with a preserved EF, whereas anemia was an independent predictor of all-cause death in men with a reduced EF. Conversely, anemia was an independent predictor of all-cause death in women with a preserved EF but not in women with a reduced EF. With respect to cardiac death, multivariable analyses revealed highly similar trends as those for all-cause death in patients of both genders. In conclusion, in acute decompensated patients with HF with a preserved or reduced EF, there were marked differences between men and women with respect to the association of anemia and left ventricular EF with survival.
在急性失代偿性心力衰竭（HF）患者中，性别对贫血、左心室射血分数（EF）及预后的影响尚不清楚。我们评估了因急性失代偿性HF住院的男性或女性患者中贫血和左心室EF与生存的相关性。在急性失代偿性心力衰竭综合征注册研究中登记的4842例患者中，纳入了4215例因急性失代偿性HF住院后存活出院的患者（2450例男性和1765例女性），以评估性别、出院时贫血（男性血红蛋白<13.0 g/dl，女性血红蛋白<12.0 g/dl）以及EF保留或降低与出院后全因死亡或心源性死亡的相关性。根据左心室EF（EF保留或降低）和出院时贫血状态将男性或女性分为4组。出院后的中位随访期为524天（384至791天）。在对多种合并症进行校正后，EF保留的男性贫血无不良影响，而EF降低的男性贫血是全因死亡的独立预测因素。相反，EF保留的女性贫血是全因死亡的独立预测因素，而EF降低的女性则不是。关于心源性死亡，多变量分析显示，两性患者的心源性死亡趋势与全因死亡趋势高度相似。总之，在EF保留或降低的急性失代偿性HF患者中，贫血和左心室EF与生存的相关性在男性和女性之间存在显著差异。
