Peak oxygen consumption and prognosis in heart failure (original) (raw)
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Comparison of Morbidity in Women Versus Men With Heart Failure and Preserved Ejection Fraction
The American Journal of Cardiology, 2006
Patients with heart failure (HF) and preserved ejection fraction (HF-PEF) constitute up to 30% to 50% of patients with HF, and HF-PEF affects women more often than men. Not much is known about the role of gender in the clinical presentation, symptoms, or disease severity of HF-PEF or about the contribution of these differences to gender differences in morbidity and mortality in patients with HF-PEF. This study examined gender differences in clinical presentation, hospitalization, and mortality in patients with HF-PEF (ejection fraction >50%) enrolled in the ancillary arm of the Digitalis Investigation Group trial. Time-to-event analysis was performed using Cox proportional-hazards modeling. The study cohort included 719 patients (378 men, 341 women). At baseline, compared with men, women were older and had greater clinical severity of HF, as evidenced by worse New York Heart Association functional class, more frequent symptoms and signs of HF, and more treatment with diuretics. Ischemia was identified as the primary cause of HF in 46% of women and 56% of men (p ؍ 0.01). During a median follow-up of 39 months, crude mortality was similar in women and men (24.6% and 24.3%, p ؍ 0.93), but more women were hospitalized for HF (26.7% vs 15.9%, p <0.001). After adjustment for baseline differences, female gender was an independent predictor of lower mortality (hazard ratio 0.59, 95% confidence interval 0.43 to 0.82), but HF hospitalization rates were similar between men and women (hazard ratio 1.09, 95% confidence interval 0.77 to 1.53). In conclusion, although the clinical manifestations of HF appear to be more severe in women with HF-PEF, after adjustment for baseline clinical differences, HF hospitalizations are not increased and survival expectancy is better for women compared with men.
Sex and Gender Differences in Heart Failure
International Journal of Heart Failure, 2020
Heart failure (HF) phenotypes differ according to sex. HF preserved ejection fraction (EF) has a greater prevalence in women and HF reduced EF (HFrEF) in men. Women with HF survive longer than men and have a lower risk of sudden death. Ischemia is the most prominent cause in men, whereas hypertension and diabetes contribute to a greater extent in women. Women with HF have a greater stiffness of the smaller left ventricle and a higher EF than men. This higher stiffness of women's hearts may be based on an increase in fibrosis at old age. In younger women estrogen reduces collagen production in female cardiac fibroblasts, but stimulates it in males. Lipid and energy metabolism is better maintained in female than in male stressed hearts. Pulse pressure is a key determinant of outcome in HF women but not in men. Takotsubo and peripartum cardiomyopathy are rare diseases affecting predominantly or exclusively women. Sudden cardiac arrest affects more men than women, but women are less adequately treated. New findings in HF therapy indicate that women with HFrEF need lower doses of beta-blockers and angiotensin-converting enzyme inhibitors than men for optimal effects. The combined neprilysin inhibitor/angiotensin II receptor blockers sacubitril-valsartan led to a significant reduction in event rate versus valsartan in women, which was not observed in men. Unfortunately, only less than 10% of recent randomized controlled trial report effects and adverse drug reactions for women and men separately. More research on sex differences in pathophysiology and therapy of HF is needed.
Gender differences in advanced heart failure: insights from the BEST study
Journal of the American College of Cardiology, 2003
The goal of this study was to determine the influence of gender on baseline characteristics, response to treatment, and prognosis in patients with heart failure (HF) and impaired left ventricular ejection fraction (LVEF). BACKGROUND Under-representation of women in HF clinical trials has limited our understanding of gender-related differences in patients with HF.
Effects of gender on peak oxygen consumption and the timing of cardiac transplantation
The Journal of Heart and Lung Transplantation, 2005
This study examines the gender effects on peak exercise oxygen consumption (VO 2 ) and survival in heart failure (HF) patients and their implications for cardiac transplantation. BACKGROUND The predictive value of peak VO 2 in women HF patients is poorly established but is one of the indicators used to optimally time cardiac transplantation in women.
International Journal of Clinical Practice, 2020
Background: Recent evidence showed that new onset (de-novo) acute heart failure (AHF) is a distinct type of AHF. However, the prognostic implication of gender on these patients remains unclear. Aims: We aimed to investigate the impact of gender on both short and long-term mortality outcomes after hospitalization for de-novo AHF. Methods: We analyzed data of 721 patients with de-novo AHF, who were enrolled in the HF survey in Israel between March and April 2003 and were followed until December 2014. Results: Fifty-four percent (N=387) of the patients were men. In comparison to women, men patients were more likely to be younger, smokers, and with ischemic HF etiology. At 30 days mortality rates were higher in women (12% vs 7%, P=0.013). Survival analysis showed that at 1 and 10 years the all-cause mortality rates were significantly higher in women (28% vs 17%, and 78% vs 67%, 1 and 10 years, P<0.001, respectively). Consistently, multivariable analysis showed that women had an independently 82% and 24% higher mortality risk at 1 and 10 years, respectively, (1-year hazard ratio=1.82; 95% confidence interval=1.07 to 3.11, P=0.03; 10-year hazard ratio=1.24; 95% confidence interval=1.03 to 1.48, P=0.02). Conclusions: Among patients with de-novo AHF, women had higher mortality rates compared to men. The observed gender related differences in de-novo AHF patients highlight the need for further and deeper research in this field.
Canadian Journal of Cardiology, 2015
Background. In heart failure (HF), females show better survival despite a comparatively low peak oxygen consumption (VO 2 ): this raises doubt about the accuracy of risk assessment by cardiopulmonary exercise testing (CPET) in females. Accordingly, we aimed to check: i) whether the predictive role of well-known CPET risk indexes, i.e. peak VO 2 and ventilatory response (VE/VCO 2 slope), is gender independent; ii) if gender-related characteristics that impact outcome in HF should be considered as associations which may confound the gender effect on survival.
Gender and risk of adverse outcomes in heart failure
The American Journal of Cardiology, 2004
Congestive heart failure (CHF) is the leading cause of hospitalization in the elderly, and these patients are at high risk for subsequent hospitalization. Whether gender affects the risk of rehospitalization in patients who have CHF is less well understood. We studied a random sample of 1,700 adults who had been hospitalized with CHF (from July 1, 1999 to June 30, 2000) and identified all readmissions through June 30, 2001. We used proportional hazards regression to evaluate whether gender affects the risk of all-cause and CHF-specific rehospitalization, after adjusting for differences in demographic characteristics, health-related behaviors, co-morbid conditions, left ventricular systolic function status, and use of CHF therapies. Among 1,591 adults who had confirmed CHF, 752 were women (47.3%). Women were older than men (73 vs 71 years, p <0.001) and more likely to have preserved systolic function (55.3% vs 40.9%, p <0.001), hypertension (83.1% vs 75.2%, p <0.001), and prior renal insufficiency (46.8% vs 34.6%, p <0.001). No significant differences existed between women and men with respect to crude rates of any readmission (144.7 vs 134.6 per 100 personyears, p ؍ 0.36) or CHF-specific readmission (39.9 vs 37.4 per 100 person-years, p ؍ 0.65). After adjusting for potential confounders, there was no significant difference between women and men with respect to risk of any readmission (adjusted hazard ratio 0.88, 95% confidence interval 0.76 to 1.02) or readmission for CHF (adjusted hazard ratio 0.89, 95% confidence interval 0.71 to 1.11). Among a contemporary, diverse population of patients who had CHF, rates of readmission overall and for CHF remained high, but gender was not independently associated with a differential risk of readmission. ᮊ2004 by Excerpta Medica, Inc.
Baseline differences in the HF-ACTION trial by sex
American Heart Journal, 2009
In patients with heart failure (HF), assessment of functional capacity plays an important prognostic role. Both 6-minute walk and cardiopulmonary exercise testing have been used to determine physical function and to determine prognosis and even listing for transplantation. However, as in HF trials, the number of women reported has been small, and the cutoffs for transplantation have been representative of male populations and extrapolated to women. It is also well known that peak VO2 as a determinant of fitness is inherently lower in women than in men and potentially much lower in the presence of HF. Values for a female population from which to draw for this important determination are lacking.The HF-ACTION trial randomized 2,331 patients (28% women) with New York Heart Association class II-IV HF due to systolic dysfunction to either a formal exercise program in addition to optimal medical therapy or to optimal medical therapy alone without any formal exercise training. To characterize differences between men and women in the interpretation of final cardiopulmonary exercise testing models, the interaction of individual covariates with sex was investigated in the models of (1) VE/VCO2, (2) VO2 at ventilatory threshold (VT), (3) distance on the 6-minute walk, and (4) peak VO2.The women were younger than the men and more likely to have a nonischemic etiology and a higher ejection fraction. Dose of angiotensin converting enzyme inhibitor (ACEI) was lower in the women, on average. The lower ACEI dose may reflect the higher use of angiotensin II receptor blocker (ARB) in women. Both the peak VO2 and the 6-minute walk distance were significantly lower in the women than in the men. Perhaps the most significant finding in this dataset of baseline characteristics is that the peak VO2 for women was significantly lower than that for men with similar ventricular function and health status.Therefore, in a well-medicated, stable, class II-IV HF cohort of patients who are able to exercise, women have statistically significantly lower peak VO2 and 6-minute walk distance than men with similar health status and ventricular function. These data should prompt careful thought when considering prognostic markers for women and listing for cardiac transplant.