title: Sex differences in clinical characteristics and long-term outcome in acute decompensated heart failure patients with preserved and reduced ejection fraction.
abstract: In patients with acute decompensated heart failure (ADHF), sex differences considering clinical and pathophysiologic features are not fully understood. We investigated sex differences in left ventricular (LV) ejection fraction (LVEF), plasma B-type natriuretic peptide (BNP) levels, and prognostic factors in patients with ADHF in Japan. We studied 748 consecutive ADHF patients of 821 patients registered in the ADHF registry between January 2007 and December 2014. Patients were divided into four groups based on sex and LVEF [reduced (ejection fraction, or EF, <50%, heart failure with reduced EF, or HFrEF) or preserved (EF ≥50%, heart failure with preserved LVEF, or HFpEF)]. The primary endpoint was the combination of cardiovascular death and heart failure (HF) admission. The present study consisted of 311 female patients (50% HFrEF, 50% HFpEF) and 437 male patients (63% HFrEF, 37% HFpEF). There was significant difference between sexes in the LVEF distribution profile. The ratio of HFpEF patients was significantly higher in female patients than in male patients (P= 0.0004). Although there were no significant sex differences in median plasma BNP levels, the prognostic value of BNP levels was different between sexes. Kaplan-Meier analysis revealed that the high BNP group had worse prognosis than the low BNP group in male but not in female patients. In multivariate analysis, log transformed BNP at discharge predicted cardiovascular events in male but not in female HF patients (female, hazard ratio: 1.169; 95% confidence interval: 0.981-1.399;P= 0.0806; male, hazard ratio: 1.289; 95% confidence interval: 1.120-1.481;P= 0.0004). In patients with ADHF, the distribution of LV function and the prognostic significance of plasma BNP levels for long-term outcome were different between the sexes.
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Nakada
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan rkawa@naramed-u.ac.jp.
authors.forename: Rika
authors.initials: R
authors.lastname: Kawakami
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Nakano
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takitsume
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Ueda
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Nishida
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Onoue
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okayama
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Yukiji
authors.initials: Y
authors.lastname: Takeda
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawata
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okura
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D013318:Stroke Volume
keywords: B-type natriuretic peptide; acute decompensated heart failure; preserved ejection fraction; sex differences