AimsThere is limited information on the sex‐specific longitudinal changes of left ventricular ejection fraction (LVEF) after an acute heart failure (AHF) hospitalization. We aimed to investigate whether LVEF trajectories over time and their impact on mortality and AHF readmission rates differ between men and women.Methods and resultsWe conducted a retrospective sex‐specific analysis of longitudinal LVEF measurements (n = 9581) in 3383 patients with an index hospitalization for AHF in a single tertiary‐level hospital. Statistical techniques suited for longitudinal data analysis were used. The mean age of the sample was 73.8 ± 11.2 years, and 47.9% were women. The mean LVEF was 49.4 ± 15.3%. At a median follow‐up of 2.58 years (interquartile range 0.77–5.62), we registered 2197 deaths (64.9%) and 2597 AHF readmissions in 1302 (38.5%) patients. The longitudinal analysis showed that women had consistently higher LVEF values throughout the follow‐up with both trajectories characterized by an early peak—approximately at 1 year—followed by decreasing values in men but a plateau in women. Multivariate between‐sex comparisons across LVEF categories revealed that women had lower rates of AHF readmissions when LVEF ≤40%. On the contrary, women displayed an excess risk of AHF readmissions when LVEF >60%. A trend in the same direction was found for cardiovascular and all‐cause mortality.ConclusionSex was a significant factor in determining the follow‐up trajectory of LVEF and predicting differences in outcomes after an AHF admission. The findings suggest that women have a higher risk of AHF readmissions at higher LVEF values, while men have a higher risk at lower LVEF values. For all‐cause and cardiovascular mortality, the same direction of the association was inferred but they were not significant.

中文翻译：

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左心室射血分数轨迹对急性心力衰竭住院后死亡和心力衰竭再入院风险的性别相关差异影响：一项纵向研究

目的关于急性心力衰竭（AHF）住院后左心室射血分数（LVEF）的性别特异性纵向变化的信息有限。我们的目的是调查男性和女性之间 LVEF 随时间变化的轨迹及其对死亡率和 AHF 再入院率的影响是否存在差异。方法和结果我们对纵向 LVEF 测量值进行了回顾性性别特异性分析（n= 9581），研究对象为 3383 名在一家三级医院因 AHF 住院的患者。使用了适合纵向数据分析的统计技术。样本的平均年龄为 73.8 ± 11.2 岁，其中 47.9% 为女性。平均 LVEF 为 49.4 ± 15.3%。在中位随访 2.58 年（四分位距 0.77-5.62）中，我们记录了 1302 名患者（38.5%）中 2197 例死亡（64.9%）和 2597 例 AHF 再入院。纵向分析显示，在整个随访过程中，女性的 LVEF 值始终较高，两条轨迹的特点是早期达到峰值（大约在 1 年），随后男性的值下降，但女性的值达到平台期。跨 LVEF 类别的多变量性别比较显示，当 LVEF ≤ 40% 时，女性 AHF 再入院率较低。相反，当 LVEF > 60% 时，女性出现 AHF 再入院的风险较高。心血管死亡率和全因死亡率呈相同方向的趋势。结论性别是确定 LVEF 随访轨迹和预测 AHF 入院后结局差异的重要因素。研究结果表明，女性在 LVEF 值较高时发生 AHF 再入院的风险较高，而男性在 LVEF 值较低时发生 AHF 再入院的风险较高。对于全因死亡率和心血管死亡率，推断出相同的关联方向，但并不显着。