Abstract
Few studies are available regarding prognostic stratification of women with severe chronic heart failure (CHF). Although women seem to have a better outcome than men, this may be due to favorable baseline characteristics. We analyzed a cohort of CHF patients referred for heart transplantation (HT) who underwent clinical/laboratory/instrumental evaluation. Women and men were frequency matched for baseline age (53 +/- 14 vs 53 +/- 9 years, p = 0.92), left ventricular ejection fraction (33 +/- 10 vs 31 +/- 8%, p = 0.90) and ischemic etiology (17 vs 22%, p = 0.50). A total of 198 patients were analyzed (109 women matched to 89 men). In addition to matching parameters, prevalence of severe symptoms, diabetes and hypertension were also comparable (p > or = 0.25). After 3 years, cardiovascular death or need for HT (CD/HT) event-free survival was 78 +/- 4% in women and 50 +/- 6% in men (p = 0.005). On multivariate analysis, female gender was associated with a lower risk of CD/HT (relative risk [RR] 0.52; 95% confidence interval [CI] 0.30 to 0.89; p = 0.017), independently of symptoms, blood pressure (BP), left ventricular end-diastolic diameter (LVEDD) and mitral regurgitation (MR). Nevertheless, CD/HT event-free survival at 3 years was 49 +/- 9% for women with New York Heart Association (NYHA) Class III or IV status, who presented with either severe MR, mean BP < or =60 mm Hg or LVEDD > or =35 mm/m2. In advanced CHF, women patients seem to have a better prognosis irrespective of baseline characteristics, supporting the hypothesis that female gender is protective against myocardial injury. However, women with severe symptoms accompanied by either hypotension, severe left ventricular enlargement or MR are at high risk and deserve cautious follow-up and consideration for HT.
Highlights
Conclusions: Reliable risk stratification in chronic heart failure (CHF) is mandatory to deliver the most appropriate therapeutic strategies, including heart transplantation (HT)
Few studies are available to help stratify the prognosis of women with severe CHF,[1] largely because female patients have been consistently under-represented both in
All consecutive patients with an established diagnosis of CHF, who were referred to the heart failure clinics of our institutions for prognostic stratification and evaluation for HT from March 1, 1996 through December 31, 2003, were screened for this study
Summary
Methods: Results: Conclusions: Reliable risk stratification in chronic heart failure (CHF) is mandatory to deliver the most appropriate therapeutic strategies, including heart transplantation (HT). These results may have been influenced by profound gender-related differences in baseline characteristics.[8] women were almost invariably older at baseline,[5,6,7] and had (when assessed) better preserved left ventricular ejection fraction (LVEF),[3] lower prevalence of ischemic etiology[3,4,5,6,7] and higher prevalence of diabetes.[6,7] because the original data included only select clinical/instrumental parameters,[1,3,4,5,6,7] it was not possible to adjust for the confounding influence of several important predictors of outcome.[2,9]
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