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Cobo Marcos M, de la Espriella R, Gayán Ordás J, Zegrí I, Pomares A, Llácer P, Fort A, Rodríguez Chavarri A, Méndez A, Blázquez Z, Caravaca Pérez P, Rubio Gracia J, Recio-Mayoral A, García Pinilla JM, Soler MJ, Garrido González R, Górriz JL, González Rico M, Castro A, Núñez J. Sex differences in Cardiorenal Syndrome: Insights from CARDIOREN Registry. Curr Heart Fail Rep 2023:10.1007/s11897-023-00598-x. [PMID: 37222949 DOI: 10.1007/s11897-023-00598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE OF THE WORK Although sex-specific differences in heart failure (HF) or kidney disease (KD) have been analyzed separately, the predominant cardiorenal phenotype by sex has not been described. This study aims to explore the sex-related differences in cardiorenal syndrome (CRS) in a contemporary cohort of outpatients with HF. FINDINGS An analysis of the Cardiorenal Spanish registry (CARDIOREN) was performed. CARDIOREN Registry is a prospective multicenter observational registry including 1107 chronic ambulatory HF patients (37% females) from 13 Spanish HF clinics. Estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73 m2 was present in 59.1% of the overall HF population, being this prevalence higher in the female population (63.2% vs. 56.6%, p = 0.032, median age: 81 years old, IQR:74-86). Among those with kidney dysfunction, women displayed higher odds of showing HF with preserved ejection fraction (HFpEF) (odds ratio [OR] = 4.07; confidence interval [CI] 95%: 2.65-6.25, p < 0.001), prior valvular heart disease (OR = 1.76; CI 95%:1.13-2.75, p = 0.014), anemia (OR: 2.02; CI 95%:1.30-3.14, p = 0.002), more advanced kidney disease (OR for CKD stage 3: 1.81; CI 95%:1.04-3.13, p = 0.034; OR for CKD stage 4: 2.49, CI 95%:1.31-4.70, p = 0.004) and clinical features of congestion (OR:1.51; CI 95%: 1.02-2.25, p = 0.039). On the contrary, males with cardiorenal disease showed higher odds of presenting HF with reduced ejection fraction (HFrEF) (OR:3.13; CI 95%: 1.90-5.16, p < 0.005), ischemic cardiomyopathy (OR:2.17; CI 95%: 1.31-3.61, p = 0.003), hypertension (OR = 2.11; CI 95%:1.18-3.78, p = 0.009), atrial fibrillation (OR:1.71; CI 95%: 1.06-2.75, p = 0.025), and hyperkalemia (OR:2.43, CI 95%: 1.31-4.50, p = 0.005). In this contemporary registry of chronic ambulatory HF patients, we observed sex-related differences in patients with combined heart and kidney disease. The emerging cardiorenal phenotype characterized by advanced CKD, congestion, and HFpEF was predominantly observed in women, whereas HFrEF, ischemic etiology, hypertension, hyperkalemia, and atrial fibrillation were more frequently observed in men.
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Affiliation(s)
- Marta Cobo Marcos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jara Gayán Ordás
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Isabel Zegrí
- Department of Cardiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Antonia Pomares
- Department of Cardiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Pau Llácer
- Internal Medicine Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain. Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - Aleix Fort
- Department of Cardiology, Hospital Universitari Dr. Josep Trueta., Girona, Spain
| | | | - Ana Méndez
- Department of Cardiology, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Zorba Blázquez
- Department of Cardiology, Hospital Universtiario Gregorio Marañón, Madrid, Spain
| | | | - Jorge Rubio Gracia
- Department of Internal Medicine, Hospital Universitario Lozano Blesa, University of Zaragoza, Saragossa, Spain
| | | | | | - Maria Jose Soler
- Department of Nephrology, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Ramón Garrido González
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
| | - Jose Luis Górriz
- Department of Nephrology, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Miguel González Rico
- Department of Nephrology, Hospital Clínico Universitario Valencia (INCLIVA), University of Valencia, Valencia, Spain
| | - Almudena Castro
- Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain.
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Roibal Pravio J, Barge Caballero E, Barbeito Caamaño C, Paniagua Martin MJ, Barge Caballero G, Couto Mallon D, Pardo Martinez P, Grille Cancela Z, Blanco Canosa P, García Pinilla JM, Vázquez Rodríguez JM, Crespo Leiro MG. Determinants of maximal oxygen uptake in patients with heart failure. ESC Heart Fail 2021; 8:2002-2008. [PMID: 33773098 PMCID: PMC8120347 DOI: 10.1002/ehf2.13275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Maximum oxygen uptake (VO2max) is an essential parameter to assess functional capacity of patients with heart failure (HF). We aimed to identify clinical factors that determine its value, as they have not been well characterized yet. Methods We conducted a retrospective, observational, single‐centre study of 362 consecutive patients with HF who underwent cardiopulmonary exercise testing (CPET) as part of standard clinical assessment since 2009–2019. CPET was performed on treadmill, according to Bruce's protocol (n = 360) or Naughton's protocol (n = 2). We performed multivariable linear regression analyses in order to identify independent clinical predictors associated with peak VO2max. Results Mean age of study patients was 57.3 ± 10.9 years, mean left ventricular ejection fraction was 32.8 ± 14.2%, and mean VO2max was 19.8 ± 5.2 mL/kg/min. Eighty‐nine (24.6%) patients were women, and 114 (31.5%) had ischaemic heart disease. Multivariable linear regression analysis identified six independent clinical predictors of VO2max, including NYHA class (B coefficient = −2.585; P < 0.001), age (B coefficient per 1 year = −0.104; P < 0.001), tricuspid annulus plane systolic excursion (B coefficient per 1 mm = +0.209; P < 0.001), body mass index (B coefficient per 1 kg/m2 = −0.172; P = 0.002), haemoglobin (B coefficient per 1 g/dL = +0.418; P = 0.007) and NT‐proBNP (B coefficient per 1000 pg/mL = −0.142; P = 0.019). Conclusions The severity of HF (NYHA class, NT‐proBNP) as well as age, body composition and haemoglobin levels influence significantly exercise capacity. In patients with HF, the right ventricular systolic function is of greater importance for the physical capacity than the left ventricular systolic function.
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Affiliation(s)
| | - Eduardo Barge Caballero
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Cayetana Barbeito Caamaño
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain
| | - Maria Jesus Paniagua Martin
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Gonzalo Barge Caballero
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - David Couto Mallon
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Pardo Martinez
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain
| | - Zulaika Grille Cancela
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Paula Blanco Canosa
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain
| | - Jose Manuel García Pinilla
- Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Unidad de Insuficiencia Cardiaca y Cardiopatias Familiares, Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Jose Manuel Vázquez Rodríguez
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Generosa Crespo Leiro
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
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