Baseline differences in the HF-ACTION trial by sex (original) (raw)
Related papers
Gender related predictors of limited exercise capacity in heart failure
IJC Heart & Vessels, 2013
Aim: The aim of this study was to investigate the impact of gender on the prediction of limited exercise capacity in heart failure (HF) patients assessed by 6 minute walk test (6-MWT). Methods: In 147 HF patients (mean age 61 ± 11 years, 50.3% male), a 6-MWT and a Doppler echocardiographic study were performed in the same day. Conventional cardiac measurements were obtained and global LV dyssynchrony was indirectly assessed using total isovolumic time − t-IVT [in s/min; calculated as: 60 − (total ejection time − total filling time)] and Tei index (t-IVT/ejection time). Patients were divided into two groups according to gender, which were again divided into two subgroups based on the 6-MWT distance (Group I: ≤ 300 m, and Group II: N 300 m). Results: Female patients were younger (p = 0.02), and had higher left ventricular (LV) ejection fraction -EF (p = 0.007) but with similar 6-MWT distance to male patients (p = 68). Group I male patients had lower hemoglobin level (p = 0.02) and lower EF (p = 0.03), compared with Group II, but none of the clinical or echocardiographic variables differed between groups in female patients. In multivariate analysis, only t-IVT [0.699 (0.552-0.886), p = 0.003], and LV EF [0.908 (0.835-0.987), p = 0.02] in males, and NYHA functional class [4.439 (2.213-16.24), p = 0.02] in females independently predicted poor 6-MWT distance (b300 m). Conclusion: Despite similar limited exercise capacity, gender determines the pattern of underlying cardiac disturbances; ventricular dysfunction in males and subjective NYHA class in female heart failure patients.
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.
Frontiers in Cardiovascular Medicine, 2023
Background: We aimed to test the di erences in peak VO between males and females in patients diagnosed with heart failure (HF), using combined stress echocardiography (SE) and cardiopulmonary exercise testing (CPET). Methods: Patients who underwent CPET and SE for evaluation of dyspnea or exertional intolerance at our institution, between January and December , were included and retrospectively assessed. Patients were divided into three groups: HF with preserved ejection fraction (HFpEF), HF with mildly reduced or reduced ejection fraction (HFmrEF/HFrEF), and patients without HF (control). These groups were further stratified by sex. Results: One hundred seventy-eight patients underwent CPET-SE testing, of which % were females. Females diagnosed with HFpEF showed attenuated increases in end diastolic volume index (P =. for sex × time interaction), significantly elevated E/e' (P < .), significantly decreased left ventricle (LV) end diastolic volume:E/e ratio (P =. for sex × time interaction), and lesser increases in A-VO di erence (P =. for sex × time interaction), comparing to males with HFpEF. Females diagnosed with HFmrEF/HFrEF showed diminished increases in end diastolic volume index (P =. for sex × time interaction), mostly after anaerobic threshold was met, comparing to males with HFmrEF/HFrEF. This resulted in reduced increases in peak stroke volume index (P =. for sex × time interaction) and cardiac output (P =. for sex × time interaction). Conclusions: Combined CPET-SE testing allows for individualized non-invasive evaluation of exercise physiology stratified by sex. Female patients with HF have lower exercise capacity compared to men with HF. For females diagnosed with HFpEF, this was due to poorer LV compliance and attenuated peripheral oxygen extraction, while for females diagnosed with HFmrEF/HFrEF, this was due to attenuated increase in peak stroke volume and cardiac output. As past studies have shown di erences in clinical outcomes between females and males, this study provides an essential understanding of the di erences in exercise physiology in HF patients, which may improve patient selection for targeted therapeutics.
2006
Background: Cardiopulmonary exercise testing (CPX) clearly holds prognostic value in the heart failure (HF) population. Studies investigating the prognostic value of CPX in individuals with HF have consistently examined predominantly male groups. The purpose of the present study was to examine the prognostic value of CPX in a female HF group. Methods: Seventy-five female and 337 male subjects diagnosed with HF participated in this study. The ability of peak oxygen consumption (VO 2 ) and the minute ventilation/carbon dioxide production (VE/VCO 2 ) slope to predict cardiac-related events were assessed. Results: In the year following CPX, the female group suffered 26 cardiac-related events (8 deaths/18 hospitalizations), while the male group suffered 89 cardiac-related events (20 deaths/69 hospitalizations). The hazard ratios for peak VO 2 and the VE/VCO 2 slope were 4.0 (95% confidence interval: 2.6 -6.1, p < 0.001) and 4.2 (95% confidence interval: 2.7 -6.6, p < 0.001) in the male group and 3.8 (95% confidence interval: 1.7 -8.5, p < 0.001) and 4.3 (95% confidence interval: 1.8 -9.8, p < 0.001) in the female group. In both the male and female groups, Cox multivariate analysis revealed VE/VCO 2 slope was the strongest predictor of cardiac-related events while peak VO 2 added significant predictive value and was retained in the regression.
JAMA Cardiology, 2019
IMPORTANCE Sex differences in heart failure with preserved ejection fraction (HFpEF) have been established, but insights into the mechanistic drivers of these differences are limited. OBJECTIVE To examine sex differences in cardiometabolic profiles and exercise hemodynamic profiles among individuals with HFpEF. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted at a single-center tertiary care referral hospital from December 2006 to June 2017 and included 295 participants who met hemodynamic criteria for HFpEF based on invasive cardiopulmonary exercise testing results. We examined sex differences in distinct components of oxygen transport and utilization during exercise using linear and logistic regression models. The data were analyzed from June 2018 to May 2019. MAIN OUTCOMES AND MEASURES Resting and exercise gas exchange and hemodynamic parameters obtained during cardiopulmonary exercise testing. RESULTS Of 295 participants, 121 (41.0%) were men (mean [SD] age, 64 [12] years) and 174 (59.0%) were women (mean [SD] age, 61 [13] years). Compared with men, women with HFpEF in this tertiary referral cohort had fewer comorbidities, including diabetes, insulin resistance, and hypertension, and a more favorable adipokine profile. Exercise capacity was similar in men and women (percent predicted peak oxygen [O 2 ] consumption: 66% in women vs 68% in men; P = .38), but women had distinct deficits in components of the O 2 pathway, including worse biventricular systolic reserve (multivariable-adjusted analyses: ΔLVEF β = −1.70; SE, 0.86; P < .05; ΔRVEF β = −2.39, SE=0.80; P = .003), diastolic reserve (PCWP/CO: β = 0.63; SE, 0.31; P = .04), and peripheral O 2 extraction (C(a-v)O 2 β=-0.90, SE=0.22; P < .001). CONCLUSIONS AND RELEVANCE Despite a lower burden of cardiometabolic disease and a similar percent predicted exercise capacity, women with HFpEF demonstrated greater cardiac and extracardiac deficits, including systolic reserve, diastolic reserve, and peripheral O 2 extraction. These sex differences in cardiac and skeletal muscle responses to exercise may illuminate the pathophysiology underlying the development of HFpEF and should be investigated further.
Sex-related differences in chronic heart failure
International journal of cardiology, 2018
The prevalence of chronic heart failure (CHF) is steadily increasing. Both sexes are affected, with significant differences in etiology, epidemiology and clinical presentation, prognosis, comorbidities, and response to treatment. Women tend to develop CHF at a more advanced age, present more often with HF with preserved ejection fraction, are more symptomatic, and have a worse quality of life than men, but also a better prognosis. In women, CHF has more frequently a non-ischemic etiology, and arterial hypertension and diabetes mellitus are leading comorbidities. Furthermore, many sex-related differences have been detected in the response to treatment, for example a greater prognostic benefit from angiotensin-receptor blockers in women, a higher incidence of complications after defibrillator implantation, and a greater response to cardiac resynchronization therapy. Furthermore, women are less likely to receive defibrillator therapy or heart transplantation. The significant underrepre...
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.
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.
Circulation, 2007
Background— We wished to test previous hypotheses that sex-related differences in mortality and morbidity may be due to differences in the cause of heart failure or in left ventricular ejection fraction (LVEF) by comparing fatal and nonfatal outcomes in women and men with heart failure and a broad spectrum of left ventricular ejection fraction. Methods and Results— We compared outcomes in 2400 women and 5199 men randomized in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program using multivariable regression analyses. A total of 1188 women (50%) had a low LVEF (≤0.40), and 1212 had a preserved LVEF (>0.40). Among the men, 3388 (65%) had a low LVEF, and 1811 had a preserved LVEF. A total of 1216 women (51%) and 3465 men (67%) had an ischemic cause of their heart failure. All-cause mortality was 21.5% in women and 25.3% in men (adjusted hazard ratio [HR], 0.77; 95% CI, 0.69 to 0.86; P <0.001). Fewer women (30.4%) than men (33.3%) e...