Abstract 4368094: Sex-specific differences in acute heart failure: clinical presentation, imaging, and recovery trajectories

Background: Sex-based differences in chronic heart failure are well established, but evidence regarding sex disparities in acute heart failure (AHF) is limited. Understanding these differences is critical for guiding tailored diagnostics and potentially improving clinical outcomes. Methods: This prospective, two-centre observational cohort study (2022-2024) enrolled adult patients hospitalized with signs and symptoms of AHF. Transthoracic echocardiography, 8-zone lung ultrasound (LUS), and laboratory tests were conducted shortly after admission and at follow-up 1-3 months post-discharge. The primary endpoint was a composite of all-cause mortality or AHF readmission within 180 days from enrolment. Results: Among 567 patients (mean age 78.2±11.6 years), 248 (43.7%) were female. Females were older, had a higher prevalence of atrial fibrillation and hypertension, whereas males had higher rates of hypercholesterolemia and ischemic heart disease. Upon admission, females more often presented with palpitations, peripheral edema, and tachyarrythmia-induced AHF, while males more frequently had chest pain and coronary artery disease-driven AHF. Females had better left ventricular ejection fraction (38 [31-49] vs 35% [27-45], p<0.001), and global longitudinal strain (10.5±4.7 vs. 9.7%±4.4, p=0.04), but higher relative wall thickness (0.51 [0.40-0.70] vs 0.47 [0.40-0.60], p=0.002) and lower left ventricular mass index (113 [88-145] vs.136 g/m 2 [112-172], p<0.001). Males had worse pulmonary congestion on LUS as reflected by total B-line count (5 [1-12] vs. 2 [0-9], p=0.003). Both sexes experienced significant within-group improvements in several markers at follow-up, including NT-proBNP levels, left ventricular mass index, global longitudinal strain, and tricuspid annular plane systolic excursion. There were no significant between-sex differences in recovery trajectories of echocardiographic or LUS parameters. Additionally, there was no significant sex difference in the 180-day composite outcome in either unadjusted or adjusted models. Conclusion: Despite notable differences in baseline characteristics and imaging profiles, females and males with AHF had similar short-term outcomes and recovery trajectories. These results suggest that sex-based differences in clinical presentation and imaging do not translate into disparities in early outcomes. Further research is needed to clarify whether these sex-specific baseline differences affect long-term prognosis or management in AHF.