Supra-normal and mildly reduced ejection fraction in women -An overlooked vulnerable subpopulation in heart failure.

Autor: Kawai A; Department of Cardiology, National Defense Medical College, Tokorozawa, Japan., Nagatomo Y; Department of Cardiology, National Defense Medical College, Tokorozawa, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan. Electronic address: con401@ndmc.ac.jp., Yukino-Iwashita M; Department of Cardiology, National Defense Medical College, Tokorozawa, Japan., Ikegami Y; Department of Cardiology, National Defense Medical College, Tokorozawa, Japan., Takei M; Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan., Goda A; Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan., Kohno T; Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan., Mizuno A; Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan., Kitamura M; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan., Nakano S; Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Japan., Sakamoto M; Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan., Shiraishi Y; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan., Kohsaka S; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan., Adachi T; Department of Cardiology, National Defense Medical College, Tokorozawa, Japan., Yoshikawa T; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Aug 15; Vol. 409, pp. 132166. Date of Electronic Publication: 2024 May 12.
DOI: 10.1016/j.ijcard.2024.132166
Abstrakt: Background: Recently, patients with supra-normal left ventricular ejection fraction (snEF) are reported to have high risk of adverse outcomes, especially in women. We sought to evaluate sex-related differences in the association between LVEF and long-term outcomes in heart failure (HF) patients.
Methods: The multicenter WET-HF Registry enrolled all patients hospitalized for acute decompensated HF (ADHF). We analyzed 3943 patients (age 77 years; 40.1% female) registered from 2006 to 2017. According to LVEF the patients were divided into the 3 groups: HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF) and preserved EF. The primary endpoint was defined as the composite of cardiac death and ADHF rehospitalization after discharge.
Results: In HFmrEF, implementation of guideline-directed medical therapy (GDMT) such as the combination of renin-angiotensin-system inhibitor (RASi) and β-blocker at discharge was significantly lower in women than men even after adjustment for covariates (p = 0.007). There were no such sex-related differences in HFrEF. Female sex was associated with higher incidence of the primary endpoint and ADHF rehospitalization after adjustment for covariates exclusively in HFmrEF. Restricted cubic spline analysis demonstrated a U-shaped relationship between LVEF and the hazard ratio of the primary endpoint showing higher event rate in HFmrEF and HFsnEF in women, but such relationship was not observed in men (p for interaction = 0.037).
Conclusions: In women, mrEF and snEF were associated with worse long-term outcomes. Additionally, sex-related differences in the GDMT implementation for HFmrEF highlight the need for further exploration, which might lead to creation of sex-specific guidelines to optimize HF management.
Competing Interests: Declaration of competing interest The authors declare no conflicts of interest.
(Copyright © 2023. Published by Elsevier B.V.)
Databáze: MEDLINE
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