Abstract
Background
In this study we evaluated the influence of sex on the left ventricular end-diastolic
dimension (LVEDD) and adverse outcomes in patients hospitalized for acute decompensated
heart failure (HF) with a reduced ejection fraction (EF).
Methods
Among the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes
(ATTEND) registry, 2367 patients (1607 men and 760 women) discharged alive after hospitalization
for acute decompensated HF with a reduced EF (defined as a left ventricular EF < 50%)
were investigated to assess the association of sex and LVEDD with the primary end
point (all-cause death and readmission for HF after discharge). Men and women were
separately divided into LVEDD quartiles at discharge (men: LVEDD ≤ 54, 55-60, 61-65,
and ≥ 66 mm; women: LVEDD ≤ 48, 49-54, 55-60, and ≥ 61 mm). The median follow-up period
after discharge was 524 (range, 385-785) days.
Results
Occurrence of the primary end point did not differ between men and women (37.0% vs
37.2%; P = 0.921). After adjustment for multiple comorbidities including left ventricular
EF, men with an LVEDD of 61-65 and ≥ 66 mm had a significantly higher risk of the
primary end point than men with an LVEDD ≤ 54 mm, indicating a positive association
between a larger LVEDD and adverse outcomes. In contrast, in women, the adjusted risk
of the primary end point was comparable among the LVEDD quartiles.
Conclusions
Men and women with acute decompensated HF and a reduced EF might show important differences
in relation to the association between left ventricular cavity dilation and outcomes.
Résumé
Introduction
Dans la présente étude, nous avons évalué l’influence du sexe sur la dimension du
ventricule gauche en fin de diastole (DVGFD) et l’évolution défavorable des patients
hospitalisés en raison d’une insuffisance cardiaque (IC) décompensée associée à une
fraction d’éjection (FE) réduite.
Méthodes
Parmi les 4842 patients inscrits au registre ATTEND (Acute Decompensated Heart Failure Syndromes), 2367 patients (1607 hommes et 760 femmes) qui sont sortis de l’hôpital en vie après
l’hospitalisation en raison d’une IC aiguë décompensée associée à une FE réduite (c’est-à-dire
une FE du ventricule gauche < 50 %) ont fait l’objet de l’étude sur l’évaluation de
l’association du sexe et de la DVGFD au critère d’évaluation principal (la mortalité
toutes causes confondues et la réadmission en raison d’une IC après la sortie de l’hôpital).
Nous avons réparti les hommes et les femmes en quartiles distincts de DVGFD à la sortie
de l’hôpital (les hommes ayant une DVGFD ≤ 54, de 55 à 60, de 61 à 65 et ≥ 66 mm ;
les femmes ayant une DVGFD ≤ 48, de 49 à 54, de 55 à 60 et ≥ 61 mm). La période médiane
de suivi après la sortie de l’hôpital était de 524 (étendue, de 385 à 785) jours.
Résultats
La survenue du critère d’évaluation principal ne différait pas entre les hommes et
les femmes (37,0 % vs 37,2 % ; P = 0,921). Après l’ajustement des comorbidités multiples, dont la FE du ventricule
gauche, les hommes ayant une DVGFD de 61 à 65 et ≥ 66 mm étaient exposés à un risque
significativement plus élevé du critère d’évaluation principal que les hommes ayant
une DVGFD ≤ 54 mm, ce qui montre une association positive entre une plus grande DVGFD
et une évolution défavorable. En revanche, nous avons observé que le risque ajusté
du critère d’évaluation principal chez les femmes était comparable dans tous les quartiles
de DVGFD.
Conclusions
Les hommes et les femmes ayant une IC aiguë décompensée et une FE réduite montreraient
des différences importantes en ce qui concerne l’association entre la dilatation de
la cavité ventriculaire gauche et l’évolution de la maladie.
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Article info
Publication history
Published online: February 04, 2018
Accepted:
January 21,
2018
Received:
October 27,
2017
Footnotes
See page 483 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
