Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.
Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
Int J Cardiol. 2021 Jul 1;334:126-134. doi: 10.1016/j.ijcard.2021.04.061. Epub 2021 Apr 30.
We aimed to assess differences in clinical characteristics, prognosis, and the temporal evolution of circulating biomarkers in male and female patients with HFrEF.
We included 250 patients (66 women) with chronic heart failure (CHF) between 2011 and 2013 and performed trimonthly blood sampling during a median follow-up of 2.2 years [median (IQR) of 8 (5-10) urine and 9 (5-10) plasma samples per patient]. After completion of follow-up we measured 8 biomarkers. The primary endpoint (PE) was the composite of cardiac death, cardiac transplantation, left ventricular assist device implantation, and hospitalization due to acute or worsened CHF. Joint models were used to determine whether there were differences in the temporal patterns of the biomarkers between men and women as the PE approached.
A total of 66 patients reached the PE of which 52 (78.8%) were male and 14 (21.2%) were female. The temporal patterns of all studied biomarkers were associated with the PE, and overall showed disadvantageous changes as the PE approached. For NT-proBNP, HsTnT, and CRP, women showed higher levels over the entire follow-up duration and concomitant numerically higher hazard ratios [NT-proBNP: women: HR(95%CI) 7.57 (3.17-21.93), men: HR(95%CI) 3.14 (2.09-4.79), p for interaction = 0.104, HsTnT: women: HR(95%CI) 6.38 (2.18-22.46), men: HR(95%CI) 4.91 (2.58-9.39), p for interaction = 0.704, CRP: women: HR(95%CI) 7.48 (3.43-19.53), men: HR(95%CI) 3.29 [2.27-5.44], p for interaction = 0.106). In contrast, temporal patterns of glomerular and tubular renal markers showed similar associations with the PE in men and women.
Although interaction terms are not statistically significant, the associations of temporal patterns of NT-proBNP, HsTnT, and CRP appear more outspoken in women than in men with HFrEF, whereas associations seem similar for temporal patterns of creatinine, eGFR, Cystatin C, KIM-1 and NAG. Larger studies are needed to confirm these potential sex differences.
本研究旨在评估男性和女性射血分数降低心衰（HFrEF）患者在临床特征、预后和循环生物标志物的时间演变方面的差异。
我们纳入了 2011 年至 2013 年间的 250 名慢性心衰（CHF）患者（66 名女性），并在中位随访 2.2 年期间（每名患者的中位（IQR）尿样和血样分别为 8（5-10）和 9（5-10）份）进行每三个月一次的采血。在随访结束时，我们测量了 8 种生物标志物。主要终点（PE）是心脏死亡、心脏移植、左心室辅助装置植入以及因急性或恶化的 CHF 而住院的复合终点。联合模型用于确定随着 PE 的接近，男性和女性的生物标志物时间模式是否存在差异。
共有 66 名患者达到了 PE，其中 52 名（78.8%）为男性，14 名（21.2%）为女性。所有研究生物标志物的时间模式均与 PE 相关，并且随着 PE 的接近，总体上显示出不利的变化。对于 NT-proBNP、HsTnT 和 CRP，女性在整个随访期间显示出更高的水平，并且同时具有更高的危险比[NT-proBNP：女性：HR（95%CI）7.57（3.17-21.93），男性：HR（95%CI）3.14（2.09-4.79），p 交互=0.104，HsTnT：女性：HR（95%CI）6.38（2.18-22.46），男性：HR（95%CI）4.91（2.58-9.39），p 交互=0.704，CRP：女性：HR（95%CI）7.48（3.43-19.53），男性：HR（95%CI）3.29[2.27-5.44]，p 交互=0.106）。相比之下，肾小球和肾小管肾标志物的时间模式与男性和女性的 PE 具有相似的关联。
尽管交互项在统计学上不显著，但 NT-proBNP、HsTnT 和 CRP 的时间模式与 HFrEF 女性患者的关联似乎比男性患者更为明显，而肌酐、eGFR、胱抑素 C、KIM-1 和 NAG 的时间模式的关联似乎相似。需要更大规模的研究来证实这些潜在的性别差异。
