Are there sex-based differences in myocardial injury in Acute Heart Failure?
Background and Hypothesis:
Myocardial injury in acute heart failure (AHF) contributes to worse outcomes. Whether there are sex-based differences in organ injury in AHF is not well known. This study was designed to assess potential sex-based differences in myocardial injury, as defined by high-sensitivity troponin T (hsTnT) levels, in patients presenting in ED with AHF. We hypothesized that men with AHF have higher hsTnT levels.
This is a preliminary analysis from the TACIT study, a large, prospective, multi-center, observational, biomarker cohort study. Adult patients diagnosed and treated for AHF, with a systolic blood pressure >100mmHg, and enrolled within 3 hours of first AHF therapy were eligible. Febrile patients, short life-expectancy, ACS, AF with RVR >130bpm, transplant, VAD, or ESRD were excluded. hsTnT were drawn at baseline and 3 hours later. Hemolyzed samples were disregarded as hemolysis falsely lowers hsTnT. A multivariable linear regression model was used to adjust for potential differences in baseline hsTnT using clinically meaningful covariates.
Of 527 enrolled, 499 comprised the final analysis set. Of these patients, 413 had a non-hemolyzed baseline hsTnT. Notably, more men than women were enrolled; men had higher mean baseline hsTnT values (48.3ng/mL, SD(74.5)) than women (28.3ng/mL SD(39.9)). After multivariable adjustment, baseline hsTnT differences by sex remained significant (p <0.0001).
Conclusion and Potential Impact:
Men with AHF have higher baseline levels of myocardial injury than women. These differences may need to be taken into account for risk-stratification as well as management.