Una rara complicación de la ecocardiografía de esfuerzo / An unusual complication of exercise echocardiography

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Influencia del sexo en el perfil clínico y pronóstico de la insuficiencia cardiaca tras el alta hospitalaria / Influence of gender on the clinical characteristics and prognosis of patients hospitalized for heart failure

Introducción y objetivos. La historia natural de la insuficiencia cardiaca puede ser distinta en mujeres, debido a su diferente perfil clínico, terapéutico y pronóstico. Nuestro objetivo fue definir las características diferenciales de mujeres hospitalizadas por insuficiencia cardiaca. Métodos. Estudiamos prospectivamente a los pacientes consecutivos dados de alta con el diagnóstico de insuficiencia cardiaca (n = 412). Al alta, se registraron las variables clínicas, analíticas, ecocardiográficas y terapéuticas. Durante el seguimiento (16 ± 9 meses) se registraron mortalidad y reingreso hospitalario. Resultados. Respecto a los varones, las mujeres (n = 157; 38%) presentaron: mayor edad (75 ± 12 y 71 ± 18 años; p < 0,001), hipertensión arterial (el 71 y el 51%; p < 0,001) e ingresos previos por insuficiencia cardiaca (el 36 y el 25%; p = 0,02); mayor prevalencia de fracción de eyección del ventrículo izquierdo (FEVI) preservada (el 44 y el 21%; p < 0,001); menor prevalencia de cardiopatía isquémica (el 34 y el 49%; p = 0,007) y mayor de hipertensiva (el 17 y el 8%; p = 0,006); peor función renal (52 ± 25 y 58 ± 25 ml/min/1,73 m2; p = 0,002) y menos hemoglobina (12,1 ± 1,7 y 12,9 ± 1,9; p < 0,001). Este perfil clínico conllevó menos coronariografías (el 22 y el 37%; p = 0,001), antiplaquetarios (el 45 y el 62%; p = 0,001) y bloqueadores beta (el 39 y el 50%; p = 0,03); el sexo femenino tiene relación con menos uso de estatinas (el 31 y el 45%; p = 0,003). Sin embargo, su mortalidad (el 23 contra el 18%; p = 0,26) y sus reingresos hospitalarios (el 44 y el 46%; p = 0,81) fueron similares. En mujeres, los predictores independientes de muerte fueron edad (p = 0,036; hazard ratio [HR] = 1,05 [1,01-1,09]) y anemia (p = 0,015; HR = 2,43 [1,16-5,12]). Conclusiones. Las mujeres hospitalizadas por insuficiencia cardiaca presentan un perfil clínico diferente, con FEVI más preservada y mayores comorbilidades, que conlleva un manejo terapéutico distinto. Su pronóstico es similar al de los varones (AU)

Background and objectives. The natural history of heart failure (HF) may be different in women due to their clinical characteristics, treatment and prognosis being distinct. Our aim was to describe the differential characteristics of women hospitalized with HF. Methods. We prospectively studied consecutive patients who were discharged with a diagnosis of HF (n=412). Clinical, laboratory, echocardiographic, and therapeutic variables were recorded at discharge. During follow-up (16 [9] months), all-cause mortality and the need for rehospitalization were recorded. Results. Compared with men, women (n=157, 38%) were older (75 [12] years vs. 71 [18] years, P<.001), had a higher prevalence of arterial hypertension (71% vs. 51%, P<.001), had more frequently been previously hospitalized for HF (36% vs. 25%, P=.02), had a higher prevalence of HF with a preserved left ventricular ejection fraction (LVEF) (44% vs. 21%, P<001), had less coronary disease (34% vs. 49%, P=.007), had more hypertensive cardiomyopathy (17% vs. 8%, P=.006), had worse renal function (52 [25] vs. 58 [25] mL/min per 1.73m2, P=.002), and had lower hemoglobin levels (12.1 [1.7] vs. 12.9 [1.9] g/dL, P<.001). This clinical profile resulted in less use of coronary angiography (22% vs. 37%, P=.001), antiplatelet drugs (45% vs. 62%, P=.001), and beta-blockers (39% vs. 50%, P=.03). In addition, women received statin treatment less often (31% vs. 45%, P=.003). Nevertheless, mortality (23% vs. 18%, P=.26) and the rehospitalization rate (44% vs. 46%, P=.81) were similar. In women, age (hazard ratio [HR] = 1.05, 95% confidence interval [CI] 1.01­1.09; P=.036) and anemia (HR = 2.43, 95% CI 1.16­5.12; P=.015) were independent predictors of death. Conclusions. Women hospitalized for HF had a distinct clinical profile: their LVEF was greater and they more frequently had comorbid conditions. This led to different treatment, though prognosis was similar to that in men (AU)