Sex differences in systolic heart failure in the elderly: The prognostic importance of left ventricular mass in women

Hypothesis: We investigated the hypothesis that there are prognostic differences in the importance of left ventricular (LV) mass and function between male and female patients hospitalized with heart failure. Methods: Patients >= 60 years old hospitalized with New York Heart Association class II-IV heart failure and LV systolic dysfunction were prospectively followed for >= 18 months. At study start, a physical examination and echocardiography were performed, and blood chemistry samples were obtained. Results: Of 158 patients, 66 (42%) women were included and were followed for a mean of 3.1 years. The women were older (77 +/- 7 vs. 74 +/- 7 years, p < 0.01) and had lower mortality (24% vs. 43%, p < 0.05) than the men. No gender differences in etiology or medication were found. LV mass index (LVMI 132 +/- 42 vs. 156 +/- 21 g/m(2), p < 0.01) was lower in women. Mortality in women was related to lower LV ejection fraction, larger LV volumes, and higher LVMI (all p < 0.05). In multivariate analysis, LVMI was the strongest independent mortality predictor in women (adjusted hazard ratio [HR] LMVI > 125 g/m(2) 7.4 [1.5-35.5], p = 0.01), whereas this association was not found in men. Conclusions: In patients hospitalized with systolic heart failure, women had lower mortality than men. In women, an increased LVMI was a stronger predictor of mortality than traditional measures of LV size and function. LVMI should be considered for assessment of prognosis in women with heart failure.