A055 Sex Differences in Ventricular Remodeling and Long-Term Heart Failure Outcomes Following Acute Coronary Syndrome

Abstract

Compared with men, women are at increased risk of heart failure hospitalisation following acute coronary syndrome (ACS). We investigated whether this increased hazard was associated with differing left ventricular (LV) remodelling patterns over the first 12 months after ACS. In a prospective multi-centre observational cohort study, 2,140 patients with ACS underwent echocardiography at 1, 4, and 12 months. Heart failure events were captured over a median 4.8 (IQR 3.4-6.5) years and relative risk compared between women and men using a multivariable Cox model adjusted for baseline demographics (age and systolic blood pressure) and echocardiographic variables (LV end-diastolic and end-systolic volumes, LV ejection fraction, septal wall thickness, and E/e') captured at 1 and 12 months. The 609 (28.5%) women were older, had higher blood pressure, demonstrated smaller increases in cardiac biomarkers, and were less likely to undergo revascularisation during the index admission (41.9% versus 62.0%; p<0.001 for all). After indexing, women had smaller LV end-diastolic and end-systolic volumes, greater LV ejection fractions, and greater septal wall thickness and diastolic filling pressure estimates (E/e' 14 versus 11; p<0.001 for all). Diastolic volumes further diverged at 12 months (p=0.05) and septal wall thickness increased compared with men (p=0.016). In unadjusted and adjusted analyses women were at increased risk of heart failure hospitalisation (unadjusted HR 1.5, 95%CI 1.2-1.9, adjusted HR 1.6, 95%CI 1.1-2.4). Women experience a more concentric remodeling pattern following ACS. Women remain at increased risk of long-term heart failure hospitalisation after accounting for clinical and echocardiographic characteristics.Tabled 1≤65 years (n=963)>65 years (n=1177)pSex, men755 (78.4)776 (65.9)<0.001Systolic BP, mmHg124.22 (20.08)132.69 (22.42)<0.001LV end diastolic volume, indexed to BSA65.86 (19.27)65.87 (22.20)0.997% change from 1 to 12 months1.81 (26.47)3.59 (24.55)0.220LV end systolic volume, indexed to BSA28.64 (15.57)30.62 (19.23)0.029% change from 1 to 12 months2.60 (35.36)6.70 (41.09)0.064 Open table in a new tab