Sex Differences in Cardiac and Clinical Phenotypes and Their Relation to Outcomes in Patients with Heart Failure

Area of Science:

• Cardiology
• Sex-based Medicine
• Translational Research

Background:

• Biological sex is a critical determinant of heart failure (HF) patient phenotypes.
• Sex-specific differences exist in left ventricular (LV) remodeling, with women often showing concentric remodeling and diastolic dysfunction, while men exhibit eccentric remodeling and systolic dysfunction.
• Supra-normal ejection fraction (snLVEF) is a recently identified risk factor for adverse outcomes, potentially more prevalent in female HF patients.

Purpose of the Study:

• To review and discuss sex differences in cardiac and clinical phenotypes within heart failure.
• To explore the relationship between these sex-specific phenotypes and patient outcomes.
• To propose tailored treatment strategies for female heart failure patients.

Main Methods:

• Review of existing literature on sex differences in heart failure.
• Analysis of cardiac and clinical phenotypes related to sex.
• Discussion of potential pathophysiological mechanisms, including coronary microvascular dysfunction, sympathetic overactivation, estrogen deficit, and body composition.

Main Results:

• Significant sex differences in LV remodeling patterns and HF phenotypes are observed.
• Supra-normal ejection fraction (snLVEF) may represent a greater risk in female patients.
• Factors such as estrogen deficit, body composition, and underutilization of guideline-directed medical therapy (GDMT) in women with heart failure with reduced ejection fraction (HFrEF) may contribute to outcome disparities.

Conclusions:

• Understanding sex-based differences in HF is essential for personalized medicine.
• Further research into mechanisms like coronary microvascular dysfunction and hormonal influences is needed.
• Developing sex-specific treatment strategies is crucial for improving outcomes in all HF patients, particularly women.