Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
Scand Cardiovasc J. 2020 Dec;54(6):361-368. doi: 10.1080/14017431.2020.1792972. Epub 2020 Jul 15.
To examine clinical characteristics and outcomes in women and men referred for advanced heart failure (HF) therapies such as left ventricular assist device (LVAD) or heart transplantation (HTx). A retrospective study of 429 (23% women) consecutive adult HF patients not on inotropic or mechanical circulatory support with left ventricular ejection fraction ≤45% referred for assessment of advanced HF therapies at a single tertiary institution between 2002 and 2016. Clinical characteristics and outcomes were compared in women and men, and all patients underwent right heart catheterization (RHC). At evaluation, women were younger than men (48 ± 13 vs. 51 ± 12 years, = .02), and less likely to have ischemic cardiomyopathy. There were no significant differences in NYHA class, contemporary HF therapy use, or physical examination findings, except for lower jugular vein distension and body surface area in women. On RHC, women had lower cardiac filling pressures, but similar pulmonary vascular resistance and cardiac index. Peak oxygen uptake from cardiopulmonary exercise testing was similar in both sexes. At total follow-up time, there were 164 deaths (21% vs. 44%, < .0001), 46 LVADs (3% vs. 13%, = .005), 110 HTxs (32% vs. 25%, = .15), and 82 HTxs without requiring LVAD (29% vs. 16%, = .03) in women and men. The time from RHC to HTx (±LVAD) was significantly shorter in women compared to men. Female sex was significantly associated with higher survival independent of time-trend, age, and comorbidities. At evaluation, hemodynamics were less deranged in women. A higher proportion of women received HTx, their waitlist time was shorter, and survival greater.
为了研究接受左心室辅助装置（LVAD）或心脏移植（HTx）等先进心力衰竭（HF）治疗的女性和男性的临床特征和结局。这是一项回顾性研究，纳入了 2002 年至 2016 年期间在一家三级医疗机构因评估先进 HF 治疗而转诊的 429 名（23%为女性）连续成年 HF 患者，这些患者未接受正性肌力或机械循环支持，且左心室射血分数≤45%。比较了女性和男性的临床特征和结局，所有患者均接受了右心导管检查（RHC）。在评估时，女性比男性年轻（48±13 岁比 51±12 岁， = .02），且更不可能患有缺血性心肌病。除女性颈静脉扩张度和体表面积较低外，NYHA 分级、当代 HF 治疗的使用和体格检查结果在女性和男性之间无显著差异。在 RHC 上，女性的心脏充盈压较低，但肺动脉阻力和心指数相似。心肺运动试验中的峰值摄氧量在两性之间相似。在总随访期间，女性和男性的死亡人数分别为 164 人（21%比 44%， < .0001）、46 例 LVAD（3%比 13%， = .005）、110 例 HTx（32%比 25%， = .15）和 82 例无需 LVAD 的 HTx（29%比 16%， = .03）。与男性相比，女性从 RHC 到 HTx（±LVAD）的时间明显更短。女性的性别与存活率独立于时间趋势、年龄和合并症显著相关。在评估时，女性的血液动力学紊乱程度较轻。更多的女性接受了 HTx，她们的候补名单时间更短，存活率更高。
