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

Abstract

The impact of sex on the assessment of congestion in acute heart failure (AHF) is still a matter of debate. The objective of this analysis was to evaluate sex differences in the evaluation of congestion at admission in patients hospitalized for AHF. We consecutively enrolled 494 AHF patients (252 female). Clinical congestion assessment, B-type natriuretic peptide levels analysis, blood urea nitrogen to creatinine ratio (BUN/Cr), plasma volume status estimate (by means of Duarte or Kaplam-Hakim PVS), and hydration status evaluation through bioimpedance analysis were performed. There was no difference in medications between men and women. Women were older (79 ± 9 yrs vs. 77 ± 10 yrs, p = 0.005), and had higher left ventricular ejection fraction (45 ± 11% vs. 38 ± 11%, p < 0.001), and lower creatinine clearance (42 ± 25 mL/min vs. 47 ± 26 mL/min, p = 0.04). The prevalence of peripheral oedema, orthopnoea, and jugular venous distention were not significantly different between women and men. BUN/Cr (27 ± 9 vs. 23 ± 13, p = 0.04) and plasma volume were higher in women than men (Duarte PVS: 6.0 ± 1.5 dL/g vs. 5.1 ± 1.5 dL/g, p < 0.001; Kaplam–Hakim PVS: 7.9 ± 13% vs. −7.3 ± 12%, p < 0.001). At multivariate logistic regression analysis, female sex was independently associated with BUN/Cr and PVS. Female sex was independently associated with subclinical biomarkers of congestion such as BUN/Cr and PVS in patients with AHF. A sex-guided approach to the correct evaluation of patients with AHF might become the cornerstone for the correct management of these patients.

Sex Differences in Repolarization Markers: Telemonitoring for Chronic Heart Failure Patients

“…The main results of our study demonstrated that male and female patients with CHF have different conditions and parameters to be considered in clinical practice [8,12,13]. As already highlighted in previous studies [8,19], women suffering from heart failure have a substantially more preserved ejection fraction than men (Table 2); this aspect is easily explained considering the CHF physiopathology, characterized by the greater prevalence of hypertensive heart disease, diabetic disorders, and microvessel impairment, rather than the well-known ischemic heart disease affecting the large epicardial coronary vessels among men.…”

“…As evidenced by many recent studies [8][9][10][11][12][13][14], heart failure in women shows extremely peculiar characteristics. In fact, a later age at the diagnosis [8] affects more women than men; less women receive implantable devices and resynchronization therapy [8,9].…”

“…The physiopathology of the ischemic damage is strictly related to the endothelial dysfunction and micro-vessel damage [15][16][17], which, in women, lead to a CHF with a more preserved ejection fraction than in men [8]. For this reason, symptoms, clinical course, therapeutic response, and prognosis [13,[18][19][20] (Table 1) are peculiar, and the repolarization ECG patterns [21,22] and specific markers of clinical curse and prognosis should also be evaluated [13,14,16,17]. High "revolving door" risk -High costs for the health systems -Reduced patients' quality of life Specific diagnostic and therapeutic interventions, together with an education program to enhance clinicians' and women's awareness, are desirable [23].…”

Impact of Sex and Gender Differences on Heart Failure, Especially in Elderly Patients

“…While the impact of sex on the assessment of congestion in HF is still a matter of debate, the female sex is independently associated with different levels of the biomarkers of congestion, such as the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) [43][44][45].…”

“…The levels of circulating NT-proBNP are higher in postmenopausal women versus similarly aged men due to higher cardiac stretching [43][44][45], and the greater visceral adipose tissue increases neprilysin activity, which counteracts the microvascular inflammation [56]. Other studies [17,52,53] found that in women, the amount of central fat and density of fat in the breasts plays a role as a CVRF in the occurrence of MACEs and outcomes in HF and also that this CVRF is unrelated to the other established CVRFs.…”