Exploring gender differences in trajectories of clinical markers and symptoms after left ventricular assist device implantation

Abstract

Aims: Despite well-known gender differences in heart failure, it is unknown if clinical markers and symptoms differ between women and men after left ventricular assist device (LVAD) implantation. Our aim was to examine gender differences in trajectories of clinical markers (echocardiographic markers and plasma biomarkers) and symptoms from pre- to post-LVAD implantation.

Methods and results: This was a secondary analysis of data collected from a study of patients from pre- to 1, 3, and 6 months post-LVAD implantation. Data were collected on left ventricular internal end-diastolic diameter (LVIDd) and ejection fraction (LVEF), plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP), and soluble suppressor of tumorigenicity (sST2). Physical and depressive symptoms were measured using the Heart Failure Somatic Perception Scale and Patient Health Questionnaire-9, respectively. Latent growth curve modelling was used to compare trajectories between women and men. The average age of the sample (n = 98) was 53.3 ± 13.8 years, and most were male (80.6%) and had non-ischaemic aetiology (65.3%). Pre-implantation, women had significantly narrower LVIDd (P < 0.001) and worse physical symptoms (P = 0.041) compared with men. Between pre- and 6 months post-implantation, women had an increase in plasma sST2 followed by a decrease, whereas men had an overall decrease (slope: P = 0.014; quadratic: P = 0.011). Between 1 and 6 months post-implantation, women had a significantly greater increase in LVEF (P = 0.045) but lesser decline in plasmoa NT-proBNP compared with men (P = 0.025).

Conclusion: Trajectories of clinical markers differed somewhat between women and men, but trajectories of symptoms were similar, indicating some physiologic but not symptomatic gender differences in response to LVAD.

Keywords: Biomarker; Gender; Symptoms; Ventricular assist device.

Figure 1

Trajectories of echocardiographic parameters in women and men pre- to post- left ventricular assist device implantation. Left ventricular internal end-diastolic diameter. (A) and left ventricular ejection fraction (B) (shown as mean and 95% confidence interval on the graph and mean and standard error of the mean in the table) were measured in women (dashed line) and men (solid line) from pre- to 6 months post-implantation. In the first month post-implantation, both women (n = 19) and men (n = 77) had a significant decrease in left ventricular internal end-diastolic diameter (women: z = −5.21, P < 0.001; men: z = −7.45, P < 0.001); between 1 and 6 months post-implantation, only women had a significant decrease (women: z = −2.88, P = 0.004; men: z = −0.97, P = 0.333). Comparing trajectories, pre-implantation left ventricular internal end-diastolic diameter was significantly different between women and men, but the changes thereafter were not significantly different. In the first month post-implantation, neither women (n = 19) nor men (n = 78) had a significant change in left ventricular ejection fraction (women: z = 0.63, P = 0.528; men: z = −0.62, P = 0.537); between 1 and 6 months post-implantation, both women and men had a significant increase in left ventricular ejection fraction (women: z = 2.44, P = 0.015; men: z = 2.55, P = 0.011). Comparing trajectories, neither pre-implantation left ventricular ejection fraction nor changes in the first month were significantly different between women and men; however, women had a significantly greater increase in left ventricular ejection fraction between 1 and 6 months post-implantation compared with men. LVEF, left ventricular ejection fraction; LVIDd, left ventricular internal end-diastolic diameter.

Figure 2

Trajectories of plasma biomarkers in women and men pre- to post-left ventricular assist device implantation. Plasma natural log of N-terminal pro-B-type natriuretic peptide (A) and natural log of soluble supressor of tumorigenicity levels (B) (shown as mean and 95% confidence interval on the graph and mean and standard error of the mean in the table) were measured in women (dashed line) and men (solid line) from pre- to 6 months post-implantation. In the first month post-implantation, neither women (n = 19) nor men (n = 76) had significant changes in plasma natural log of N-terminal pro-B-type natriuretic peptide (women: z = 0.29, P = 0.772; men: z = −0.60, P = 0.550); between 1 and 6 months post-implantation, only men had a significant decrease (women: z = −0.96, P = 0.339; men: z = −6.03, P < 0.001). Comparing trajectories, neither pre-implantation plasma natural log of N-terminal pro-B-type natriuretic peptide nor changes in the first month were significantly different between women and men; between 1 and 6 months post-implantation, however, men had a greater decline in plasma natural log of N-terminal pro-B-type natriuretic peptide compared with women. Between pre- and 6-months post-implantation, women (n = 19) did not have significant changes in plasma natural log of soluble suppressor of tumorigenicity (linear: z = 1.14, P = 0.253; quadratic: z = −1.71, P = 0.088) but men (n = 77) did (linear: z = −3.80, P < 0.001; quadratic: z = 2.69, P = 0.007). Comparing trajectories, pre-implantation plasma natural log of soluble suppressor of tumorigenicity was not significantly different between women and men, but both the linear and quadratic changes were significantly different. lnNT-pro-BNP, natural log of N-terminal pro-B-type natriuretic peptide; lnsST2, natural log of soluble suppressor of tumorigenicity.

Figure 3

Trajectories of symptoms in women and men pre- to post-left ventricular assist device implantation. Physical symptoms (A) and depressive symptoms (B) (shown as mean and 95% confidence interval on the graph and mean and standard error of the mean in the table) were measured in women (dashed line) and men (solid line) from pre- to 6 months post- implantation. In the first month post-implantation, both women (n = 19) and men (n = 76) had significant decreases in physical symptoms (women: z = −4.32, P < 0.001; men: z = −7.16, P < 0.001); between 1 and 6 months post-implantation, women and men continued to have significant decreases (women: z = −2.46, P = 0.014; men: z = −2.79, P = 0.005). Comparing trajectories, pre-implantation physical symptoms were significantly different between women and men; however, changes in the first month and between 1 and 6 months post-implantation were not significantly different. In the first month post-implantation, both women (n = 19) and men (n = 76) had significant decreases in depressive symptoms (women: z = −2.78, P = 0.005; men: z = −6.28, P < 0.001); between 1 and 6 months post-implantation, only men continued to have significant decreases (women: z = −0.27, P = 0.788; men: z = −2.44, P = 0.015). Comparing trajectories, there was no significant difference in pre-implantation depressive symptoms nor in changes thereafter between women and men.