Abumayyaleh Mohammad, Krack Carina, Demmer Jonathan, Pilsinger Christina, Schupp Tobias, Behnes Michael, Sattler Katherine, El-Battrawy Ibrahim, Hamdani Nazha, Akin Ibrahim
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr-University Bochum, Bochum, Germany.
Front Cardiovasc Med. 2024 Dec 19;11:1503414. doi: 10.3389/fcvm.2024.1503414. eCollection 2024.
Women with heart failure with reduced ejection fraction (HFrEF) often experience worse clinical outcomes compared to men, including higher rates of mortality, hospitalization, and congestion. However, the effects of sacubitril/valsartan on these outcomes, as well as on ventricular tachyarrhythmias, have not been well studied in women with HFrEF.
This study included consecutive series of patients treated with sacubitril/valsartan at University Hospital Mannheim from 2016 to 2020. Baseline and follow-up data were compared between women and men. The endpoints included all-cause mortality, ventricular tachyarrhythmias, all-cause hospitalization, and congestion.
A total of 246 patients were analyzed, comprising 50 (20.3%) women and 196 (79.7%) men. The study population consisted of 34.3% ambulatory patients and 65.7% hospitalized patients admitted for acute decompensated or symptomatic HF. The sex distribution was as follows: among women, 48.6% were ambulatory and 51.4% were hospitalized, while among men, 30.6% were ambulatory and 69.4% were hospitalized. Ischemic cardiomyopathy (ICM) was less common as a cause of heart failure (HF) in women than in men (32% vs. 57.7%, = 0.001). During the 12-month follow-up, left ventricular ejection fraction (LVEF) improved more significantly in women than in men, increasing from 29.0% (10.0-45.0) to 40.0% (15.0-59.0) in women ( = 0.009) compared to an increase from 28.0% (3.0-65.0) to 33.0% (13.0-60.0) in men. There were no significant differences in all-cause mortality at 12-month between women and men (4% vs. 6.7%; = 0.742). The results indicated no significant differences between the sexes in the incidence of ventricular tachyarrhythmias [ventricular fibrillation [VF] and sustained ventricular tachycardia [VT]] (4.5% vs. 0.6%; = 0.121) (2.3% vs. 3.9%; = 1.00), hospitalizations (70.2% vs. 67.8%; = 0.769), congestion at 12-month follow-up (11.4% vs. 10.1%; = 0.762). Female sex was not identified as a predictor for the occurrence of ventricular tachyarrhythmias or mortality rate at 12 months [hazard ratio (HR), 0.586; 95%-confidence interval (CI) 0.17-2.016; = 0.397] (HR, 1.898; 95%-CI 0.381-9.464; = 0.434).
Women with HFrEF treated with sacubitril/valsartan showed a greater improvement in LVEF compared to men, though clinical outcomes were similar across sexes. Female sex was not a predictor of ventricular tachyarrhythmias or mortality at 12 months.
与男性相比，射血分数降低的心力衰竭（HFrEF）女性患者往往有更差的临床结局，包括更高的死亡率、住院率和充血发生率。然而，沙库巴曲缬沙坦对这些结局以及室性快速心律失常的影响，在HFrEF女性患者中尚未得到充分研究。
本研究纳入了2016年至2020年在曼海姆大学医院接受沙库巴曲缬沙坦治疗的连续系列患者。比较了女性和男性的基线及随访数据。终点包括全因死亡率、室性快速心律失常、全因住院和充血。
共分析了246例患者，其中女性50例（20.3%），男性196例（79.7%）。研究人群包括34.3%的门诊患者和65.7%因急性失代偿或有症状的心力衰竭而住院的患者。性别分布如下：女性中，48.6%为门诊患者，51.4%为住院患者；男性中，30.6%为门诊患者，69.4%为住院患者。缺血性心肌病（ICM）作为心力衰竭（HF）的病因在女性中比在男性中少见（32%对57.7%，P = 0.001）。在12个月的随访期间，女性左心室射血分数（LVEF）的改善比男性更显著，女性从29.0%（10.0 - 45.0）增加到40.0%（15.0 - 59.0）（P = 0.009），而男性从28.0%（3.0 - 65.0）增加到33.0%（13.0 - 60.0）。女性和男性在12个月时的全因死亡率无显著差异（分别为4%和6.7%；P = 0.742）。结果表明，室性快速心律失常[心室颤动（VF）和持续性室性心动过速（VT）]的发生率在性别上无显著差异（分别为4.5%和0.6%；P = 0.121）（分别为2.3%和3.9%；P = 1.00），住院率（分别为70.2%和67.8%；P = 0.769），12个月随访时的充血发生率（分别为11.4%和10.1%；P = 0.762）。女性未被确定为12个月时室性快速心律失常或死亡率的预测因素[风险比（HR），0.586；95%置信区间（CI）0.
