Gender-related differences in heart failure with preserved ejection fraction

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Clinical Research

Background:

• Heart failure with preserved ejection fraction (HFpEF) disproportionately affects women, yet gender-specific differences remain understudied.
• Understanding these disparities is crucial for tailored patient management and improved outcomes in HFpEF.

Purpose of the Study:

• To investigate and delineate significant gender-based differences in a well-characterized cohort of patients with HFpEF.
• To identify how gender influences clinical presentation, disease progression, and mortality in HFpEF.

Main Methods:

• Prospective enrollment of 260 HFpEF patients.
• Invasive hemodynamic assessment, cardiac magnetic resonance imaging, and exercise testing were performed.
• Follow-up assessed cardiac death, a composite of HF hospitalization or cardiac death, and all-cause death.

Main Results:

• Men exhibited poorer exercise capacity and higher comorbidity burden compared to women.
• Male patients presented with more severe pulmonary vascular disease, characterized by elevated diastolic pressures and reduced right ventricular ejection fraction.
• Male gender was an independent predictor of cardiac death (9.2% incidence), but not the composite endpoint or all-cause mortality (17.3% incidence).

Conclusions:

• Distinct gender-specific phenotypes and outcomes exist within the HFpEF population.
• Men with HFpEF are more susceptible to developing a right heart phenotype and experiencing cardiac death.
• Women with HFpEF may be more likely to die from causes other than the direct progression of HFpEF.