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Canadian Journal of Cardiology

Sex Differences in Left Ventricular Cavity Dilation and Outcomes in Acute Heart Failure Patients With Left Ventricular Systolic Dysfunction

Published:February 04, 2018DOI:https://doi.org/10.1016/j.cjca.2018.01.019

      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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