Sex differences in clinical profile, left ventricular remodeling and cardiovascular outcomes among diabetic patients with heart failure and reduced ejection fraction: a cardiac-MRI-based study

• Published in: Cardiovascular diabetology Vol. 23; no. 1; pp. 266 - 10
• Main Authors: Shi, Ke, Zhang, Ge, Fu, Hang, Li, Xue-Ming, Jiang, Li, Gao, Yue, Qian, Wen-Lei, Shen, Li-Ting, Xu, Hua-Yan, Li, Yuan, Guo, Ying-Kun, Yang, Zhi-Gang
• Format: Journal Article
• Language: English
• Published: London BioMed Central 22.07.2024; BMC
• Subjects: Aged; Anemia; Angiology; Cardiac magnetic resonance imaging; Cardiology; Cardiomyopathy; Cardiovascular disease; Cardiovascular diseases; Congestive heart failure; Diabetes; Diabetes mellitus; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Diabetes Mellitus - mortality; Diabetes Mellitus - physiopathology; Ejection fraction; Etiology; Female; Gadolinium; Gender differences; Glucose; Health Status Disparities; Heart Disease Risk Factors; Heart failure; Heart Failure - diagnosis; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - physiopathology; Heart failure with reduced ejection fraction; Heart rate; Hemoglobin; Hospitals; Humans; Ischemia; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Cine; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Outcomes; Peptides; Population studies; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Sex; Sex differences; Sex Factors; Software; Stroke Volume; Survival; Survival analysis; Time Factors; Ventricle; Ventricular Function, Left; Ventricular Remodeling; Womens health; United States > US; Heart failure with reduced ejection fraction; Diabetes mellitus; Cardiac magnetic resonance imaging; Outcomes; Sex
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-024-02362-4

Background Heart failure with reduced ejection fraction (HFrEF) is associated with a high rate of mortality and morbidity. Evidence has shown that sex differences may be an important contributor to phenotypic heterogeneity in patients with HFrEF. Although diabetes mellitus (DM) frequently coexists with HFrEF and results in a worse prognosis, there remains a need to identify sex-related differences in the characteristics and outcomes of this population. In this study, we aimed to investigate the between-sex differences in clinical profile, left ventricular (LV) remodeling, and cardiovascular risk factors and outcomes in patients with HFrEF concomitant with DM. Methods A total of 273 patients with HFrEF concomitant with DM who underwent cardiac MRI were included in this study. Clinical characteristics, LV remodeling as assessed by cardiac MRI, and cardiovascular risk factors and outcomes were compared between sexes. Results Women were older, leaner and prone to have anemia and hypoproteinemia but less likely to have ischemic etiology. Cardiac MRI revealed that despite similar LVEFs between the sexes, there was more LV concentric remodeling, less impaired global systolic peak strain in longitudinal and circumferential components and a decreased likelihood of late gadolinium enhancement presence in women than in men. During a median follow-up time of 34.6 months, women exhibited better overall survival than men did (log-rank P = 0.042). Multivariable Cox proportional hazards analysis indicated different risk factors for predicting outcomes between sexes, with hypertension [hazard ratio (HR) = 2.05, 95% confidence interval (CI) 1.05 to 4.85, P = 0.041] and hypoproteinemia (HR = 2.27, 95% CI 1.06 to 4.37, P = 0.039) serving as independent determinants of outcomes in women, whereas ischemic etiology (HR = 1.96, 95% CI 1.11 to 3.48, P = 0.021) and atrial fibrillation (HR = 1.86, 95% CI 1.02 to 3.41, P = 0.044) served as independent determinants of outcomes in men. Conclusions Among patients with HFrEF concomitant with DM, women displayed different LV remodeling and risk factors and had better survival than men did. Sex-based phenotypic heterogeneity in patients with HFrEF in the context of DM should be addressed in clinical practice.