Sex differences on new-onset heart failure in patients with known or suspected coronary artery disease
Por:
Nunez, J, Lorenzo, M, Minana, G, Palau, P, Monmeneu, JV, Lopez-Lereu, MP, Gavara, J, Marcos-Garces, V, Rios-Navarro, C, Perez, N, de Dios, E, Nunez, E, Sanchis, J, Chorro, FJ, Bayes-Genis, A and Bodi, V
Publicada:
1 dic 2021
Ahead of Print:
1 may 2021
Resumen:
Aims The impact of sex in patients with CAD has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with known or suspected CAD. We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected coronary artery disease (CAD) undergoing vasodilator stress cardiac magnetic resonance (CMR).
Methods and results We prospectively evaluated 5899 consecutive HF-free patients submitted to stress CMR for known or suspected CAD. Ischaemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association between sex and new-onset HF (including outpatient diagnosis or acute HF hospitalization) was evaluated using a Cox proportional hazards regression model adjusted for competing events [death, myocardial infarction (MI), and revascularization]. A total of 2289 (38.8%) patients were women. During a median follow-up of 4.5 years, 610 (10.3%) patients died, 191 (3.2%) suffered an MI, 905 (15.3%) underwent revascularization, and 314 (5.3%) developed new-onset HF. Unadjusted new-onset HF rates were higher in women than in men (1.25 vs. 0.83 per 100 person-years, P = 0.001). After comprehensive multivariate adjustment, women showed an increased risk of new-onset HF (hazard ratio 1.58, 95% confidence interval 1.182.10; P = 0.002). We found a sex-differential effect along the continuum of LVEF (P-value for interaction = 0.007). At lower LVEF, there was an increased risk in both sexes. However, compared with men, the risk of new-onset HF was higher in women with LVEF >55%.
Conclusion Women with known or suspected CAD are at a higher risk of new-onset HF. Further studies are needed to unravel the mechanisms behind these sex-related differences.
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Filiaciones:
Nunez, J:
Hosp Clin Univ Valencia, Cardiol Dept, Av Blasco Ibanez 17, Valencia 46010, Spain
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Ctr Invest Biomed Red Cardiovasc CIBER CV, Av Monforte Lemos 3-5, Madrid 28029, Spain
Univ Valencia, Fac Med & Odontol, Dept Med, Av Blasco Ibanez 15, Valencia 46010, Spain
Lorenzo, M:
Hosp Clin Univ Valencia, Cardiol Dept, Av Blasco Ibanez 17, Valencia 46010, Spain
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Minana, G:
Hosp Clin Univ Valencia, Cardiol Dept, Av Blasco Ibanez 17, Valencia 46010, Spain
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Ctr Invest Biomed Red Cardiovasc CIBER CV, Av Monforte Lemos 3-5, Madrid 28029, Spain
Univ Valencia, Fac Med & Odontol, Dept Med, Av Blasco Ibanez 15, Valencia 46010, Spain
Palau, P:
Hosp Clin Univ Valencia, Cardiol Dept, Av Blasco Ibanez 17, Valencia 46010, Spain
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Univ Valencia, Fac Med & Odontol, Dept Med, Av Blasco Ibanez 15, Valencia 46010, Spain
Monmeneu, JV:
Explorac Radiol Especiales ERESA, Cardiovasc Magnet Resonance Unit, Colon 1, Valencia 46004, Spain
Lopez-Lereu, MP:
Explorac Radiol Especiales ERESA, Cardiovasc Magnet Resonance Unit, Colon 1, Valencia 46004, Spain
Gavara, J:
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Univ Politecn Valencia, Ctr Biomat & Tissue Engn, Camino Vera S-N, Valencia 46022, Spain
Marcos-Garces, V:
Hosp Clin Univ Valencia, Cardiol Dept, Av Blasco Ibanez 17, Valencia 46010, Spain
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Rios-Navarro, C:
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Perez, N:
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
de Dios, E:
Ctr Invest Biomed Red Cardiovasc CIBER CV, Av Monforte Lemos 3-5, Madrid 28029, Spain
Nunez, E:
Hosp Clin Univ Valencia, Cardiol Dept, Av Blasco Ibanez 17, Valencia 46010, Spain
Sanchis, J:
Hosp Clin Univ Valencia, Cardiol Dept, Av Blasco Ibanez 17, Valencia 46010, Spain
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Ctr Invest Biomed Red Cardiovasc CIBER CV, Av Monforte Lemos 3-5, Madrid 28029, Spain
Univ Valencia, Fac Med & Odontol, Dept Med, Av Blasco Ibanez 15, Valencia 46010, Spain
Chorro, FJ:
Hosp Clin Univ Valencia, Cardiol Dept, Av Blasco Ibanez 17, Valencia 46010, Spain
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Ctr Invest Biomed Red Cardiovasc CIBER CV, Av Monforte Lemos 3-5, Madrid 28029, Spain
Univ Valencia, Fac Med & Odontol, Dept Med, Av Blasco Ibanez 15, Valencia 46010, Spain
:
Ctr Invest Biomed Red Cardiovasc CIBER CV, Av Monforte Lemos 3-5, Madrid 28029, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Carretera Canyet S-N, Badalona 08916, Spain
Bodi, V:
Hosp Clin Univ Valencia, Cardiol Dept, Av Blasco Ibanez 17, Valencia 46010, Spain
Inst Invest Sanitaria INCLIVA, Menendez & Pelayo 4, Valencia 46010, Spain
Ctr Invest Biomed Red Cardiovasc CIBER CV, Av Monforte Lemos 3-5, Madrid 28029, Spain
Univ Valencia, Fac Med & Odontol, Dept Med, Av Blasco Ibanez 15, Valencia 46010, Spain
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