title: Sex differences in systolic heart failure in the elderly: the prognostic importance of left ventricular mass in women.
abstract: OBJECTIVE
  We investigated the hypothesis that there are prognostic differences in the importance of left ventricular (LV) mass and function between male and female patients hospitalized with heart failure.
  
  
  METHODS
  Patients > or =60 years old hospitalized with New York Heart Association class II-IV heart failure and LV systolic dysfunction were prospectively followed for > or =18 months. At study start, a physical examination and echocardiography were performed, and blood chemistry samples were obtained.
  
  
  RESULTS
  Of 158 patients, 66 (42%) women were included and were followed for a mean of 3.1 years. The women were older (77 +/- 7 vs. 74 +/- 7 years, p < 0.01) and had lower mortality (24% vs. 43%, p < 0.05) than the men. No gender differences in etiology or medication were found. LV mass index (LVMI 132 +/- 42 vs. 156 +/- 21 g/m(2), p < 0.01) was lower in women. Mortality in women was related to lower LV ejection fraction, larger LV volumes, and higher LVMI (all p < 0.05). In multivariate analysis, LVMI was the strongest independent mortality predictor in women (adjusted hazard ratio [HR] LMVI >125 g/m(2) 7.4 [1.5-35.5], p = 0.01), whereas this association was not found in men.
  
  
  CONCLUSIONS
  In patients hospitalized with systolic heart failure, women had lower mortality than men. In women, an increased LVMI was a stronger predictor of mortality than traditional measures of LV size and function. LVMI should be considered for assessment of prognosis in women with heart failure.
authors.affiliation: Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. maritmejhert@hotmail.com
authors.forename: Marit
authors.initials: M
authors.lastname: Mejhert
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahan
authors.forename: Magnus
authors.initials: M
authors.lastname: Edner
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Persson
mesh_terms: D000368:Aged; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D020257:Ventricular Remodeling