Sex-specific bimodal clustering of left ventricular ejection fraction in patients with acute heart failure.

Abstract

AIMS:

There is an ongoing discussion whether the categorization of patients with heart failure according to left ventricular ejection fraction (LVEF) is scientifically justified and clinically relevant. Major efforts are directed towards the identification of appropriate cut-off values to correctly allocate heart failure-specific pharmacotherapy. Alternatively, an LVEF continuum without definite subgroups is discussed. This study aimed to evaluate the natural distribution of LVEF in patients presenting with acutely decompensated heart failure and to identify potential subgroups of LVEF in male and female patients.

METHODS AND RESULTS:

We identified 470 patients (mean age 75 ± 11 years, n = 137 female) hospitalized for acute heart failure in whom LVEF could be quantified by Simpson's method in an in-hospital echocardiogram. Non-parametric modelling revealed a bimodal shape of the LVEF distribution. Parametric modelling identified two clusters suggesting two LVEF peaks with mean (variance) of 61% (9%) and 31% (10%), respectively. Sub-differentiation by sex revealed a sex-specific bimodal clustering of LVEF. The respective threshold differentiating between 'high' and 'low' LVEF was 45% in men and 52% in women.

CONCLUSIONS:

In patients presenting with acute heart failure, LVEF clustered in two subgroups and exhibited profound sex-specific distributional differences. These findings might enrich the scientific process to identify distinct subgroups of heart failure patients, which might each benefit from respectively tailored (pharmaco)therapies.

• Authors: Carsten Henneges, Caroline Morbach, Floran Sahiti, Nina Scholz, Stefan Frantz, Georg Ertl, Christiane E Angermann, Stefan Störk
• Journal: ESC heart failure (ESC Heart Fail) Vol. 9 Issue 1 Pg. 786-790 (02 2022) ISSN: 2055-5822 [Electronic] England
• PMID: 34913270 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Topics

• Aged
• Aged, 80 and over
• Cluster Analysis
• Echocardiography
• Female
• Heart Failure (diagnosis)
• Humans
• Male
• Middle Aged
• Stroke Volume
• Ventricular Function, Left