Gender-related differences in heart failure with preserved ejection fraction

Franz Duca,Andreas A Kammerlander,Julia Mascherbauer,Diana Bonderman,Stefan Aschauer,Christina Binder,Caroline Zotter-Tufaro

doi:10.1038/s41598-018-19507-7

Abstract

Heart failure with preserved ejection fraction (HFpEF) affects more women than men, suggesting gender to play a major role in disease evolution. However, studies investigating gender differences in HFpEF are limited. In the present study we aimed to describe gender differences in a well-characterized HFpEF cohort. Consecutive HFpEF patients underwent invasive hemodynamic assessment, cardiac magnetic resonance imaging and exercise testing. Study endpoints were: cardiac death, a combined endpoint of HF hospitalization or cardiac death and all-cause death. 260 HFpEF patients were prospectively enrolled. Men were more compromised with regard to exercise capacity and had significantly more co-morbidities. Men had more pronounced pulmonary vascular disease with higher diastolic pressure gradients and a lower right ventricular EF. During follow-up, 9.2% experienced cardiac death, 33.5% the combined endpoint and 17.3% all-cause death. Male gender was independently associated with cardiac death, but neither with the combined endpoint nor with all-cause mortality. We detected clear gender differences in HFpEF patients. Cardiac death was more common among men, but not all-cause death. While men are more prone to develop a right heart phenotype and die from HFpEF, women are more likely to die with HFpEF.

Highlights

Heart failure (HF) is a highly morbid condition with increasing prevalence, already affecting more than 23 million people worldwide[1]
A relatively large body of evidence suggests that women are more prone to develop a hypertrophied, stiff and non-dilated left ventricular (LV), which is pathognomonic for HFpEF22,23
Results from the I-Preserve trial, which included roughly 3000 heart failure with preserved ejection fraction (HFpEF) patients detected a worse outcome for male HFpEF patients, who had a higher risk for all-cause death[6]

Summary

Introduction

Heart failure (HF) is a highly morbid condition with increasing prevalence, already affecting more than 23 million people worldwide[1]. Women significantly outnumber men, leading to a gender ratio of approximately 2:1 in HFpEF4,5. This supports the notion that gender plays a crucial role in this increasingly recognized condition. Relatively little is known about the influence of gender on clinical course and outcome in pure HFpEF cohorts without overlapping cardiac conditions, such as CAD, or mimicking conditions, such as amyloidosis[9,10]. To shed more light on the influence of gender on the course of HFpEF patients we investigated a well-characterized HFpEF cohort, from a prospective national registry and assessed differences between men and women with regards to clinical, hemodynamic and imaging parameters, as well as outcome data

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Results

Conclusion