Department of Cardiology, National Defense Medical College, Tokorozawa, Japan.
Department of Cardiology, National Defense Medical College, Tokorozawa, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Int J Cardiol. 2024 Aug 15;409:132166. doi: 10.1016/j.ijcard.2024.132166. Epub 2024 May 12.
Recently, patients with supra-normal left ventricular ejection fraction (snEF) are reported to have high risk of adverse outcomes, especially in women. We sought to evaluate sex-related differences in the association between LVEF and long-term outcomes in heart failure (HF) patients.
The multicenter WET-HF Registry enrolled all patients hospitalized for acute decompensated HF (ADHF). We analyzed 3943 patients (age 77 years; 40.1% female) registered from 2006 to 2017. According to LVEF the patients were divided into the 3 groups: HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF) and preserved EF. The primary endpoint was defined as the composite of cardiac death and ADHF rehospitalization after discharge.
In HFmrEF, implementation of guideline-directed medical therapy (GDMT) such as the combination of renin-angiotensin-system inhibitor (RASi) and β-blocker at discharge was significantly lower in women than men even after adjustment for covariates (p = 0.007). There were no such sex-related differences in HFrEF. Female sex was associated with higher incidence of the primary endpoint and ADHF rehospitalization after adjustment for covariates exclusively in HFmrEF. Restricted cubic spline analysis demonstrated a U-shaped relationship between LVEF and the hazard ratio of the primary endpoint showing higher event rate in HFmrEF and HFsnEF in women, but such relationship was not observed in men (p for interaction = 0.037).
In women, mrEF and snEF were associated with worse long-term outcomes. Additionally, sex-related differences in the GDMT implementation for HFmrEF highlight the need for further exploration, which might lead to creation of sex-specific guidelines to optimize HF management.
最近，有研究报道左心室射血分数（LVEF）高于正常值的患者（snEF）发生不良预后的风险较高，尤其是女性。本研究旨在评估 LVEF 与心力衰竭（HF）患者长期预后之间的相关性在性别上的差异。
多中心 WET-HF 注册研究纳入了所有因急性失代偿性 HF（ADHF）住院的患者。我们分析了 2006 年至 2017 年登记的 3943 例患者（年龄 77 岁；40.1%为女性）。根据 LVEF 将患者分为三组：射血分数降低的心衰（HFrEF）、射血分数轻度降低的心衰（HFmrEF）和射血分数保留的心衰（HFpEF）。主要终点定义为心脏死亡和出院后 ADHF 再住院的复合终点。
HFmrEF 组中，女性出院时接受指南指导的药物治疗（GDMT）的比例（如血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂[RASi]和β受体阻滞剂联合治疗）明显低于男性，即使在校正了混杂因素后（p = 0.007）。在 HFrEF 组中，性别与主要终点事件发生率和 ADHF 再住院率之间没有这种相关性。在校正混杂因素后，女性性别与 HFmrEF 患者的主要终点和 ADHF 再住院的发生率增加独立相关，而在男性中则没有观察到这种关系（p 交互= 0.037）。
在女性中，HFmrEF 和 snEF 与更差的长期预后相关。此外，HFmrEF 中 GDMT 实施的性别差异突出了进一步探索的必要性，这可能导致制定针对女性的特定指南，以优化 HF 管理。
