Sex differences in congestive markers in patients hospitalized for acute heart failure

Abstract

Aims We sought to examine sex differences in congestion in patients hospitalized for acute heart failure (AHF). Understanding congestive patterns in women and men with AHF may provide insights into sex differences in the presentation and prognosis of AHF patients. Methods and results In a prospective, two-site study in adults hospitalized for AHF, four-zone lung ultrasound (LUS) was performed at the time of echocardiography at baseline (LUS1) and, in a subset, pre-discharge (LUS2). B-lines on LUS and echocardiographic images were analysed offline, blinded to clinical information and outcomes. Among 349 patients with LUS1 data (median age 74, 59% male, and 87% White), women had higher left ventricular ejection fraction (mean 43% vs. 36%, P < 0.001), higher tricuspid annular plane systolic excursion (mean 17 vs. 15 mm, P = 0.021), and higher measures of filling pressures (median E/e′ 20 vs. 16, P < 0.001). B-line number on LUS1 (median 6 vs. 6, P = 0.69) and admission N-terminal pro-B-type natriuretic peptide levels (median 3932 vs. 3483 pg/mL, P = 0.77) were similar in women and men. In 121 patients with both LUS1 and LUS2 data, there was a similar and significant decrease in B-lines from baseline to discharge in both women and men. The risk of the composite 90 day outcome increased with higher B-line number on four-zone LUS2: unadjusted hazard ratio for each B-line tertile was 1.86 (95% confidence interval 1.08-3.20, P = 0.025) in women and 1.65 (95% confidence interval 1.03-2.64, P = 0.037) in men (interaction P = 0.72). Conclusions Among patients with AHF, echocardiographic markers differed between women and men at baseline, whereas B-line number on LUS did not. The dynamic changes in B-lines during a hospitalization for AHF were similar in women and men.

Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study

“…In addition, many of the patients were too ill to collaborate to be in a seated position. All of this meant that we chose not to use a 12-zone LUS model which would otherwise have allowed us to assess the posterior zones and instead chose to only assess 8 zones (frontal and lateral zones) which limits our findings although the 8-zone model has been successfully used in several other studies [31,32]. However, several sensitivity analyses were carried out which confirmed our findings in the primary analyses.…”

Sex Differences in the Evaluation of Congestion Markers in Patients with Acute Heart Failure

“…Shim et al [ 37 ] demonstrated that women are more prone to develop arterial stiffness, and this was related to modification in the cardiac parameters of diastolic function. Espersen et al [ 17 ] partially confirmed these characteristics: women with AHF showed similar prevalence in jugular venous distension and crackles on auscultation while demonstrating reduced prevalence in lower extremity oedema. Although no differences were according to instrumental evaluations (lung ultrasound and chest X-rays), the authors pointed out lower values in BUN and creatinine in women than men [ 17 ].…”

“…Espersen et al [ 17 ] partially confirmed these characteristics: women with AHF showed similar prevalence in jugular venous distension and crackles on auscultation while demonstrating reduced prevalence in lower extremity oedema. Although no differences were according to instrumental evaluations (lung ultrasound and chest X-rays), the authors pointed out lower values in BUN and creatinine in women than men [ 17 ]. BUN and BUN/Cr ratio are reliable markers of neurohormonal activation and venous congestion [ 38 ].…”

“…Nevertheless, the literature is scant regarding the influence of sex on congestion markers in patients with HF, and conflicting data emerge from the analysis of the studies [ 17 , 18 , 19 , 20 , 21 ]. Data from the CHARM-Preserved (candesartan in heart failure: assessment of the reduction in mortality and morbidity) (EF ≥ 45%), I-Preserve (irbesartan in heart failure with preserved ejection fraction), and TOPCAT-Americas (treatment of preserved cardiac function heart failure with an aldosterone antagonist trial) effectively outlined higher prevalence in signs and symptoms of congestion in women than men with HFpEF [ 18 ].…”

Prevalence and prognostic importance of lung ultrasound findings in acute coronary syndrome: A systematic review

“…demonstrated that a score comprising B‐lines along with left ventricular ejection fraction and tricuspid annular plane systolic excursion provided additional prognostic value to the GRACE and TIMI risk scores for the combined endpoint of all‐cause death and nonfatal MI during a median follow up of 5 months. By contrast, in studies among patients with acute HF, B‐lines early during the admission (baseline) are typically less prognostically important for post‐discharge outcomes than B‐lines assessed prior to hospital discharge 16,17 . While all studies in this systematic review performed LUS examinations on admission, data on B‐line number prior to hospital discharge and their prognostic relevance for subsequent outcomes such as HF‐readmissions and mortality are lacking for patients with ACS.…”