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

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.