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Sex-specific bimodal clustering of left ventricular ejection fraction in patients with acute heart failure

Carsten Henneges1, Caroline Morbach1,2, Floran Sahiti1

  • 1Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany.

ESC Heart Failure
|December 16, 2021
PubMed

Insights

Left ventricular ejection fraction (LVEF) in acute heart failure patients naturally clusters into two distinct subgroups, with significant sex-specific differences observed in LVEF distribution and thresholds.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Echocardiography

Background:

  • The clinical relevance of categorizing heart failure patients by left ventricular ejection fraction (LVEF) is debated.
  • Current research focuses on identifying precise LVEF cut-offs for targeted pharmacotherapy.
  • An alternative perspective suggests an LVEF continuum rather than distinct subgroups.

Purpose of the Study:

  • To investigate the natural distribution of LVEF in patients with acutely decompensated heart failure.
  • To identify potential LVEF subgroups within male and female patient populations.

Main Methods:

  • Analysis of 470 patients hospitalized for acute heart failure.
  • Quantification of LVEF using Simpson's method via in-hospital echocardiography.
  • Application of non-parametric and parametric modeling to assess LVEF distribution and identify clusters.

Main Results:

  • LVEF distribution exhibited a bimodal shape, indicating two primary clusters.
  • Parametric modeling identified two LVEF peaks: 61% (9% variance) and 31% (10% variance).
  • Sex-specific bimodal clustering of LVEF was observed, with thresholds of 45% for men and 52% for women differentiating high and low LVEF.

Conclusions:

  • Acutely decompensated heart failure patients demonstrate LVEF clustering into two subgroups.
  • Profound sex-specific differences exist in LVEF distribution.
  • These findings may aid in identifying distinct heart failure subgroups for tailored therapeutic strategies.
Abstract

Keywords:
Heart failureLeft ventricular ejection fractionSex differences

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