Department of Cardiology, University Heart & Vascular Centre Hamburg, Martinistrasse 52, Hamburg, 20246, Germany.
German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
ESC Heart Fail. 2021 Dec;8(6):5031-5039. doi: 10.1002/ehf2.13567. Epub 2021 Sep 6.
Despite signals from clinical trials and mechanistic studies implying different resilience to heart failure (HF) depending on gender, the impact of gender on presentation and outcomes in patients with HF remains unclear. This study assessed the impact of gender on clinical presentation and outcomes in patients with HF referred to a specialised tertiary HF service.
Consecutive patients with HF referred to a specialised tertiary HF service offering advanced therapy options including left ventricular assist devices (LVAD) and heart transplantation were prospectively enrolled from August 2015 until March 2018. We assessed clinical characteristics at baseline and performed survival analyses and age-adjusted Cox regression analyses in men vs. women for all-cause death and a combined disease-related endpoint comprising death, heart transplantation, and LVAD implantation. Analyses were performed for the overall study population and for patients with HF with reduced ejection fraction (HFrEF). Of 356 patients included, 283 (79.5%) were male. The median age was 58 years (interquartile range 50-67). Two hundred and fifty-one (74.5%) patients had HFrEF. HF aetiology, ejection fraction, functional status measures, and most of the cardiac and non-cardiac comorbidities did not differ between men and women. In a median follow-up of 3.2 years, 50 patients died (45 men, 5 women), 15 patients underwent LVAD implantation, and 8 patients heart transplantation. While all-cause death was not significantly different between both genders in the overall population [16.9 vs. 6.0%, P = 0.065, hazard ratio (HR) 2.29 (95% confidence interval 0.91-5.78), P = 0.078], in the HFrEF subgroup, a significant difference between men and women was observed [20.7% vs. 3.9%, P = 0.017, HR 3.67 (95% confidence interval 1.13-11.91), P = 0.031]. The combined endpoint was more often reached in men than in women in both the overall population [21.6% vs. 9.0%, P = 0.053, HR 2.51 (1.08-5.82), P = 0.032] and the HFrEF subgroup [27.1% vs. 7.7%, P = 0.015, HR 3.58 (1.29-9.94), P = 0.014].
Patients referred to a specialised tertiary HF service showed a similar clinical profile without relevant gender differences. In the mid-term follow-up, more male than female patients died or underwent heart transplantation and LVAD implantation. These findings call for independent validation and for further research into gender-specific drivers of HF progression.
尽管临床试验和机制研究的信号表明，性别对心力衰竭（HF）的抵抗力不同，但性别对 HF 患者的临床表现和结局的影响仍不清楚。本研究评估了性别对专门的三级 HF 服务中 HF 患者临床表现和结局的影响。
连续纳入 2015 年 8 月至 2018 年 3 月期间因 HF 被转诊至专门的三级 HF 服务机构的患者，该机构提供左心室辅助装置（LVAD）和心脏移植等先进治疗选择。我们评估了基线时的临床特征，并对男性与女性的所有原因死亡和包括死亡、心脏移植和 LVAD 植入在内的合并疾病相关终点进行了生存分析和年龄调整 Cox 回归分析。分析了总体研究人群以及射血分数降低的 HF（HFrEF）患者。356 例患者中，283 例（79.5%）为男性。中位年龄为 58 岁（四分位距 50-67）。251 例（74.5%）患者存在 HFrEF。HF 病因、射血分数、功能状态指标以及大多数心脏和非心脏合并症在男性和女性之间无差异。中位随访 3.2 年后，50 例患者死亡（45 例男性，5 例女性），15 例患者接受 LVAD 植入，8 例患者接受心脏移植。虽然在总体人群中，两性之间的全因死亡率无显著差异[16.9%比 6.0%，P=0.065，风险比（HR）2.29（95%置信区间 0.91-5.78），P=0.078]，但在 HFrEF 亚组中，男性和女性之间存在显著差异[20.7%比 3.9%，P=0.017，HR 3.67（95%置信区间 1.13-11.91），P=0.031]。在总体人群中[21.6%比 9.0%，P=0.053，HR 2.51（1.08-5.82），P=0.032]和 HFrEF 亚组中[27.1%比 7.7%，P=0.015，HR 3.58（1.29-9.94），P=0.014]，男性的联合终点发生率高于女性。
被转诊至专门的三级 HF 服务机构的患者表现出相似的临床特征，无明显性别差异。在中期随访中，更多的男性患者死亡或接受心脏移植和 LVAD 植入。这些发现需要进一步的独立验证和研究，以了解 HF 进展的性别特异性驱动因素。
