Abstract
The impact of sex on the assessment of congestion in acute heart failure (AHF) is still a matter of debate. The objective of this analysis was to evaluate sex differences in the evaluation of congestion at admission in patients hospitalized for AHF. We consecutively enrolled 494 AHF patients (252 female). Clinical congestion assessment, B-type natriuretic peptide levels analysis, blood urea nitrogen to creatinine ratio (BUN/Cr), plasma volume status estimate (by means of Duarte or Kaplam-Hakim PVS), and hydration status evaluation through bioimpedance analysis were performed. There was no difference in medications between men and women. Women were older (79 ± 9 yrs vs. 77 ± 10 yrs, p = 0.005), and had higher left ventricular ejection fraction (45 ± 11% vs. 38 ± 11%, p < 0.001), and lower creatinine clearance (42 ± 25 mL/min vs. 47 ± 26 mL/min, p = 0.04). The prevalence of peripheral oedema, orthopnoea, and jugular venous distention were not significantly different between women and men. BUN/Cr (27 ± 9 vs. 23 ± 13, p = 0.04) and plasma volume were higher in women than men (Duarte PVS: 6.0 ± 1.5 dL/g vs. 5.1 ± 1.5 dL/g, p < 0.001; Kaplam–Hakim PVS: 7.9 ± 13% vs. −7.3 ± 12%, p < 0.001). At multivariate logistic regression analysis, female sex was independently associated with BUN/Cr and PVS. Female sex was independently associated with subclinical biomarkers of congestion such as BUN/Cr and PVS in patients with AHF. A sex-guided approach to the correct evaluation of patients with AHF might become the cornerstone for the correct management of these patients.
Highlights
Sex difference is a well-established issue in a heart failure (HF) setting [1,2] as well as in the context of acute myocardial infarction [3]
Our study identified that: (1) in line with the literature, women more often suffered HF with preserved ejection fraction (HFpEF), were older, and had device implantations less frequently than men; (2) clinical congestion markers—i.e., peripheral oedema, orthopnoea and jugular veins distention—did not allow differentiating the congestion status between women and men, but blood urea nitrogen (BUN)/Cr and plasma volume status (PVS) could effectively distinguish the congestion status in relation to sex; (3) PVS, blood urea nitrogen to creatinine ratio (BUN/Cr), left ventricular ejection fraction (LVEF), and estimated glomerular filtration rate (eGFR) independently correlated with sex
While the prognostic impact of PVS in acute heart failure (AHF) has previously been demonstrated by our group [14,23], the present study demonstrated, for the first time, the role of female sex on the PVS in AHF patients
Summary
Sex difference is a well-established issue in a heart failure (HF) setting [1,2] as well as in the context of acute myocardial infarction [3]. The evaluation of congestion plays a central role in the general management of patients with acute heart failure (AHF), improving diagnosis, providing prognostic information, and guiding treatments [10]. The higher the number of signs and symptoms of congestion, the higher the risk of 30-day mortality rate in patients with AHF The literature provides data about the prognostic impact of signs of congestion in patients with both acute and chronic HF [12,13,14]. The absence of congestion is tightly related to improvements in the overall survival of patients with HF, even in those with New York Heart Association (NYHA) class IV [15,16]
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