Abstract

Objective

To examine clinical characteristics and outcomes in women and men referred for advanced heart failure (HF) therapies such as left ventricular assist device (LVAD) or heart transplantation (HTx). Design: A retrospective study of 429 (23% women) consecutive adult HF patients not on inotropic or mechanical circulatory support with left ventricular ejection fraction ≤45% referred for assessment of advanced HF therapies at a single tertiary institution between 2002 and 2016. Clinical characteristics and outcomes were compared in women and men, and all patients underwent right heart catheterization (RHC). Results: At evaluation, women were younger than men (48 ± 13 vs. 51 ± 12 years, p = .02), and less likely to have ischemic cardiomyopathy. There were no significant differences in NYHA class, contemporary HF therapy use, or physical examination findings, except for lower jugular vein distension and body surface area in women. On RHC, women had lower cardiac filling pressures, but similar pulmonary vascular resistance and cardiac index. Peak oxygen uptake from cardiopulmonary exercise testing was similar in both sexes. At total follow-up time, there were 164 deaths (21% vs. 44%, p < .0001), 46 LVADs (3% vs. 13%, p = .005), 110 HTxs (32% vs. 25%, p = .15), and 82 HTxs without requiring LVAD (29% vs. 16%, p = .03) in women and men. The time from RHC to HTx (±LVAD) was significantly shorter in women compared to men. Female sex was significantly associated with higher survival independent of time-trend, age, and comorbidities. Conclusion: At evaluation, hemodynamics were less deranged in women. A higher proportion of women received HTx, their waitlist time was shorter, and survival greater.

中文翻译：

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晚期心力衰竭男女的临床表现和预后。

摘要

目的

检验接受高级心力衰竭（HF）治疗（例如左心室辅助装置（LVAD）或心脏移植（HTx））的男女的临床特征和结果。设计：一项回顾性研究，对2002年至2016年间未接受正性肌力或机械循环支持且左心室射血分数≤45％的429名（23％女性）连续成人HF患者进行回顾性研究，以评估其先进的HF治疗。并比较了男女的结局，并对所有患者均进行了右心导管检查（RHC）。结果：在评估中，女性比男性年轻（48±13 vs. 51±12岁，p = .02），并且不太可能发生缺血性心肌病。除了女性的下颌静脉扩张和体表面积外，NYHA分级，当代HF治疗或体格检查结果无显着差异。在RHC上，女性的心脏充盈压较低，但肺血管阻力和心脏指数相似。男女心肺运动测试中的峰值摄氧量相似。在总随访时间中，有164例死亡（21％对44％，p  <.0001），46例LVAD（3％对13％，p  = .005），110 HTxs（32％对25％）。 ，p  = .15）和82 HTx，而无需LVAD（29％vs. 16％，p = .03）。与男性相比，女性从RHC到HTx的时间（±LVAD）明显缩短。女性与高生存率显着相关，而不受时间趋势，年龄和合并症的影响。结论：在评估中，女性的血液动力学变化较少。接受HTx的女性比例更高，她们的候补时间较短，生存期更长。