Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
JACC Heart Fail. 2017 Oct;5(10):735-742. doi: 10.1016/j.jchf.2017.07.011.
This study sought to investigate sex-related differences in reverse remodeling (RR).
RR, that is, the recovery from left ventricular (LV) dilation and dysfunction in response to treatment for heart failure (HF), is associated with improved prognosis.
Data from patients with stable systolic HF (LV ejection fraction [LVEF] of <50%) undergoing 2 transthoracic echocardiograms within 12 ± 2 months were analyzed. Reverse remodeling was defined as a ≥15% reduction in LV end-systolic volume index.
A total of 927 patients were evaluated (68 ± 12 years; median LVEF = 35% [interquartile range: 30% to 43%]; 27% women). Ischemic HF was less often encountered in women (33% vs. 60%, respectively; p < 0.001), whereas most characteristics did not differ with regard to sex. Women showed a higher incidence of RR (41% vs. 27%, respectively; p < 0.001), despite similar baseline LV volume and function. RR was more frequent among women in the subgroups with either ischemic or nonischemic HF, as well as in all categories of systolic dysfunction (LVEF ≤35% or >35%, according to current indication for device implantation, and LVEF <40% or 40% to 50% according to the definition of HF with reduced or mid-range EF). In the whole population, female sex was an independent predictor of RR (hazard ratio: 1.54; 95% confidence interval: 1.11 to 2.14; p = 0.011), together with cause of HF, disease duration, and left bundle branch block. Female sex was again an independent predictor of RR in all LVEF categories.
Reverse remodeling is more frequent among women, regardless of cause and severity of LV dysfunction. Female sex is an independent predictor of RR in all categories of LV systolic dysfunction.
本研究旨在探讨性别与逆重构（RR）之间的关系。
RR 是指心力衰竭（HF）治疗后左心室（LV）扩张和功能障碍的恢复，与改善预后相关。
分析了 927 例接受 2 次经胸超声心动图检查的稳定收缩性 HF 患者（LV 射血分数[LVEF]＜50%）的数据，两次检查时间间隔为 12±2 个月。RR 定义为 LV 收缩末期容积指数降低≥15%。
共评估了 927 例患者（68±12 岁；中位数 LVEF 为 35%[四分位间距：30%至 43%]；27%为女性）。女性缺血性 HF 较少见（分别为 33%和 60%，p＜0.001），而大多数特征在性别间无差异。尽管 LV 容积和功能基线相似，但女性 RR 的发生率更高（分别为 41%和 27%，p＜0.001）。RR 在缺血性或非缺血性 HF 的亚组以及所有收缩功能障碍类别（根据当前装置植入适应证，LVEF≤35%或＞35%，根据 HF 伴有射血分数降低或中间范围 EF 的定义，LVEF＜40%或 40%至 50%）中更为常见。在全人群中，女性是 RR 的独立预测因素（风险比：1.54；95%置信区间：1.11 至 2.14；p=0.011），与 HF 的病因、病程和左束支传导阻滞有关。在所有 LVEF 类别中，女性仍是 RR 的独立预测因素。
RR 在女性中更为常见，与病因和 LV 功能障碍的严重程度无关。女性是所有 LV 收缩功能障碍类别的 RR 的独立预测因素。
