Sex Differences in Heart Failure With Preserved Ejection Fraction

Area of Science:

• Cardiology
• Echocardiography
• Clinical Outcomes Research

Background:

• Heart failure with preserved ejection fraction (HFpEF) predominantly affects women, but the impact of sex on diastolic dysfunction and clinical outcomes is not fully understood.
• Existing research has not clearly defined the relationship between female sex and the severity of diastolic dysfunction or long-term prognosis in HFpEF patients.

Purpose of the Study:

• To investigate sex-specific differences in the degree of diastolic dysfunction among patients diagnosed with HFpEF.
• To evaluate the association between female sex and clinical outcomes, including all-cause mortality and heart failure readmissions, in an HFpEF cohort.

Main Methods:

• A prospective, multicenter observational study (PURSUIT-HFpEF) enrolled 871 patients with HFpEF between 2016 and 2019.
• Diastolic dysfunction was assessed using American Society of Echocardiography/European Association of Cardiovascular Imaging criteria.
• Clinical outcomes were tracked for a composite of all-cause death and heart failure readmission over a median follow-up of 399 days.

Main Results:

• Women constituted 55.2% of the cohort and were older, with lower rates of hypertension, coronary artery disease, and chronic kidney disease compared to men.
• Diastolic dysfunction was significantly more prevalent in women (52.8%) than in men (32.0%, P<0.001).
• Female sex was independently associated with both the presence of diastolic dysfunction (aOR, 2.839) and worse clinical outcomes (aHR, 1.538).

Conclusions:

• Female sex is independently associated with increased diastolic dysfunction and poorer clinical outcomes in elderly patients with HFpEF.
• These findings highlight the importance of considering sex as a critical factor in understanding HFpEF pathophysiology.
• A sex-specific approach is recommended for future research and clinical management strategies in HFpEF.