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Gender Differences in Prognostic Markers of All-Cause Death in Patients with Acute Heart Failure: a Prospective 18-Month Follow-Up Study


Acute heart failure (AHF) is a life-threatening condition with poor prognosis. Gender differences have been increasingly recognized in diverse cardiovascular diseases. The present study aimed to evaluate gender-specific prognostic markers of all-cause death in AHF patients based on a prospective 18-month follow-up study. Data were collected from 419 patients with AHF hospitalization who were followed up for 18 months using all-cause death as primary endpoint. The mean age of all patients was 60.9 ± 15.7 years old, 277 were males, and 142 were females. Females had higher rate of valvular heart disease (37.3%) and atrial fibrillation (45.8%) but lower rate of cardiomyopathy (30.3%) than males in this cohort. Based on multiple COX stepwise regression and ROC curve analysis, diastolic blood pressure (DBP), serum sodium, serum creatinine, and pulmonary artery systolic pressure (PASP) were identified as independent predictors of all-cause death in male AHF patients, while systolic blood pressure (SBP), serum aspartate transaminase (AST), serum creatinine, and serum D-dimer as independent predictors in females. Kaplan-Meier analysis showed a higher probability of all-cause death over time in male AHF patients with DBP ≤ 77 mmHg, serum sodium ≤ 138.5 mM, serum creatinine ≥ 126.2 μM, or PASP ≥ 52 mmHg, and in female AHF patients with SBP ≤ 129 mmHg, serum AST > 29.3 U/L, serum creatinine ≥ 102.7 μM, or serum D-dimer ≥ 1.76 mg/L. In conclusion, these data provide novel insights into gender differences in prognostic markers of outcomes of AHF patients.

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This work was supported by the grants from National Natural Science Foundation of China (81730106 and 81670347 to XL Li) and the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD20102013 to XL Li).

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Correspondence to Xinli Li.

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The authors declare that they have no conflict of interest.

Research Involving Human Participants and/or Animals

This study was approved by the Ethic Committee of the First Affiliated Hospital of Nanjing Medical University and registered at http://www.chictr.org/cn (Registration Number: ChiCTR-ONC-12001944). From March 2012 to October 2016, a total of 493 patients were prospectively enrolled and hospitalized for diagnosis of AHF in Cardiology Department of the First Affiliated Hospital of Nanjing Medical University, according to Chinese guidelines for the diagnosis and treatment of heart failure. Data collection included demographic characteristics, medical history, etiology and comorbidity of AHF, oral medications at admission, laboratory examination, 12-lead ECG, and echocardiography. Patients with AHF hospitalization were followed up for 18 months using all-cause death as primary endpoint.

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Wu, X., Chen, M., Wang, K. et al. Gender Differences in Prognostic Markers of All-Cause Death in Patients with Acute Heart Failure: a Prospective 18-Month Follow-Up Study. J. of Cardiovasc. Trans. Res. 13, 97–109 (2020). https://doi.org/10.1007/s12265-019-09893-2

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  • Acute heart failure
  • Gender
  • All-cause death
  • Prognosis