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. 2022 Feb 24;9(3):67.
doi: 10.3390/jcdd9030067.

Sex Differences in the Evaluation of Congestion Markers in Patients with Acute Heart Failure

Pietro Scicchitano  1 , Claudio Paolillo  2 , Micaela De Palo  3 , Angela Potenza  1 , Silvia Abruzzese  1 , Marco Basile  1 , Antonia Cannito  1 , Maria Tangorra  1 , Piero Guida  4 , Pasquale Caldarola  5 , Marco Matteo Ciccone  6 , Francesco Massari  1
Affiliations

Sex Differences in the Evaluation of Congestion Markers in Patients with Acute Heart Failure

Pietro Scicchitano et al. J Cardiovasc Dev Dis. .

Abstract

The impact of sex on the assessment of congestion in acute heart failure (AHF) is still a matter of debate. The objective of this analysis was to evaluate sex differences in the evaluation of congestion at admission in patients hospitalized for AHF. We consecutively enrolled 494 AHF patients (252 female). Clinical congestion assessment, B-type natriuretic peptide levels analysis, blood urea nitrogen to creatinine ratio (BUN/Cr), plasma volume status estimate (by means of Duarte or Kaplam-Hakim PVS), and hydration status evaluation through bioimpedance analysis were performed. There was no difference in medications between men and women. Women were older (79 ± 9 yrs vs. 77 ± 10 yrs, p = 0.005), and had higher left ventricular ejection fraction (45 ± 11% vs. 38 ± 11%, p < 0.001), and lower creatinine clearance (42 ± 25 mL/min vs. 47 ± 26 mL/min, p = 0.04). The prevalence of peripheral oedema, orthopnoea, and jugular venous distention were not significantly different between women and men. BUN/Cr (27 ± 9 vs. 23 ± 13, p = 0.04) and plasma volume were higher in women than men (Duarte PVS: 6.0 ± 1.5 dL/g vs. 5.1 ± 1.5 dL/g, p < 0.001; Kaplam−Hakim PVS: 7.9 ± 13% vs. −7.3 ± 12%, p < 0.001). At multivariate logistic regression analysis, female sex was independently associated with BUN/Cr and PVS. Female sex was independently associated with subclinical biomarkers of congestion such as BUN/Cr and PVS in patients with AHF. A sex-guided approach to the correct evaluation of patients with AHF might become the cornerstone for the correct management of these patients.

Keywords: BUN/Cr ratio; acute heart failure; congestion; plasma volume status; sex.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Differences in congestion biomarkers between male and female patients with acute heart failure. BNP: brain natriuretic peptide; BUN/Cr ratio: blood urea nitrogen/creatinine ratio; PVS: plasma volume status.
Figure 2
Figure 2
Different behaviour of HYDRA score between women and men admitted for acute heart failure.
Figure 3
Figure 3
Plasma volume status (PVS) as calculated by means of Kaplan–Hakim (KH) formula: (a) differences between men and women, and (b) evaluation of creatinine clearance on the KH-PVS estimation between the two sexes.
See this image and copyright information in PMC

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