1Busan National University Hospital - Busan - Korea (Republic of)
Background: Little is known on the gender differences in patients with heart failure (HF) with mid-range ejection fraction (EF) (HFmrEF).
Objectives: We aimed to investigate the gender differences in patients with HFmrEF.
Methods: Among 252 consecutive patients with primary diagnosis of HFmrEF (EF 40-49%) and baseline and follow-up echocardiogram in an urban tertiary referral center from October 2013 to March 2017, 131 (52.0%) were in men and 121 (48.0%) were in women. We compared the characteristics and composite event (cardiovascular death and HF readmission).
Results: Compared to women, men had significantly higher rates of prior ischemic heart disease, chronic kidney disease (CKD), and peripheral arterial disease. At baseline, LVEF was not significantly different between men and women. At follow-up, LVEF in women significantly improved from the baseline levels (48.9% vs. 45.3%, p<0.001), whereas no significant changes in LVEF were observed in men. In women, the use of inhibitor of the renin angiotensin system (odds ratio 0.39, 95% confidence interval [CI] 0.18-0.82, p=0.014) was contributed to the improvement of LVEF. Composite event occurred in 80 patients (31.7%). There were no significant differences in the composite event between men and women (32.1% vs. 31.4%, hazard ratio [HR] 1.16, 95% CI 0.74-1.81, p=0.529). Significant contributors for composite event were age (HR 1.04, 95% CI 1.01-1.06, p=0.002), the presence of atrial fibrillation (HR 1.78, 95% CI 1.15-2.76, p=0.010), spironolactone use (HR 0.56, 95% CI 0.36-0.87, p=0.009). Cardiac death occurred in 9 patients (3.6%). Men had a significantly higher rate of cardiac death than women (6.1% vs. 0.8%, HR 1.26, 95% CI 1.01-6.69, p=0.027). In men, age (HR 1.12, 95% CI 1.02-1.22, p=0.015) and CKD (HR 3.14, 95% CI 1.03-6.58, p=0.042) were independently predictive for increased risk of cardiac death.
Conclusions: This study showed that in patients with HFmrEF, women might be associated with improved LVEF and lower risk of cardiac death compared to men.