Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan.
Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Osaka Japan.
J Am Heart Assoc. 2021 Feb;10(5):e018574. doi: 10.1161/JAHA.120.018574. Epub 2021 Feb 23.
Background The female preponderance in heart failure with preserved ejection fraction (HFpEF) is a distinguishing feature of this disorder, but the association of sex with degree of diastolic dysfunction and clinical outcomes among individuals with HFpEF remains unclear. Methods and Results We conducted a prospective, multicenter, observational study of patients with HFpEF (PURSUIT-HFpEF [Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction]: UMIN000021831). Between 2016 and 2019, 871 patients were enrolled from 26 hospitals (follow-up: 399±349 days). We investigated sex-related differences in diastolic dysfunction and postdischarge clinical outcomes in patients with HFpEF. The echocardiographic end point was diastolic dysfunction according to American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. The clinical end point was a composite of all-cause death and heart failure readmission. Women accounted for 55.2% (481 patients) of the overall cohort. Compared with men, women were older and had lower prevalence rates of hypertension, coronary artery disease, and chronic kidney disease. Women had diastolic dysfunction more frequently than men (52.8% versus 32.0%, <0.001). The incidence of the clinical end point did not differ between women and men (women 36.1/100 person-years versus men 30.5/100 person-years, =0.336). Female sex was independently associated with the echocardiographic end point (adjusted odds ratio, 2.839; 95% CI, 1.884-4.278; <0.001) and the clinical end point (adjusted hazard ratio, 1.538; 95% CI, 1.143-2.070; =0.004). Conclusions Female sex was independently associated with the presence of diastolic dysfunction and worse clinical outcomes in a cohort of elderly patients with HFpEF. Our results suggest that a sex-specific approach is key to investigating the pathophysiology of HFpEF. Registration URL: https://upload.umin.ac.jp; Unique identifier: UMIN000021831.
女性在射血分数保留型心力衰竭（HFpEF）中占优势，这是该疾病的一个显著特征，但在 HFpEF 患者中，性别与舒张功能障碍的程度以及临床结局的关系尚不清楚。
我们进行了一项前瞻性、多中心、观察性研究，纳入了 871 例 HFpEF 患者（PURSUIT-HFpEF [前瞻性多中心观察性研究心力衰竭伴射血分数保留患者]：UMIN000021831）。研究时间为 2016 年至 2019 年，共纳入了 26 家医院的 871 例患者（随访：399±349 天）。我们研究了 HFpEF 患者中舒张功能障碍和出院后临床结局的性别差异。超声心动图终点为美国超声心动图学会/欧洲心血管成像协会标准定义的舒张功能障碍。临床终点为全因死亡和心力衰竭再入院的复合终点。女性占总队列的 55.2%（481 例）。与男性相比，女性年龄更大，高血压、冠心病和慢性肾脏病的患病率更低。女性舒张功能障碍的发生率高于男性（52.8%对 32.0%，<0.001）。女性和男性的临床终点发生率无差异（女性 36.1/100 人年对男性 30.5/100 人年，=0.336）。女性性别与超声心动图终点（调整优势比，2.839；95%置信区间，1.884-4.278；<0.001）和临床终点（调整风险比，1.538；95%置信区间，1.143-2.070；=0.004）独立相关。
在老年 HFpEF 患者队列中，女性性别与舒张功能障碍和临床结局恶化独立相关。我们的研究结果表明，针对性别进行研究是探究 HFpEF 病理生理学的关键。
