Abstract 2387: Sex Differences in the Relationship between Echocardiographic Parameters and Clinical Outcomes in Chronic Stable Angina: Data from the ACTION trial
Objectives: To elucidate how the association between clinical outcomes and echocardiographic parameters of size and function differ by sex in chronic stable angina.
Background: Whether men and women with stable coronary disease and similar ejection fraction (EF) have equivalent cardiac risk is unknown.
Methods: Baseline EF and end-diastolic (EDV) and end-systolic (ESV) volumes were calculated from 7016 patients in the ACTION study (A Coronary disease Trial Investigating Outcomes with Nifedipine GTS). All-cause and cardiac mortality and cardiovascular events were assessed over a mean of 4.9 years. Univariate and multivariable Cox proportional hazard models were used to determine the interaction between gender and echocardiographic parameters and clinical outcomes.
Results: There was significant effect modification by sex on the association between EF < 45% and all-cause and cardiac mortality. Relative to those with an EF ≥ 55%, women with an EF < 45% demonstrated a greater increased risk of these two endpoints (HR 4.78, 95%CI 2.16–10.57; HR 22.44, 95%CI 3.07–164.27, respectively) as compared to men (HR 1.99, 95%CI 1.42–2.79; HR 2.77, 95%CI 1.73– 4.43, respectively; interaction unadjusted p = 0.03, adjusted p = 0.06 – 0.07) (Table 1⇓). There was also significant effect modification by gender on the association between an EDV > 175ml and risk of coronary procedures (unadjusted, adjusted p = 0.02) and ESV > 100ml and risk of heart failure (unadjusted p = 0.03, adjusted p = 0.26).
Conclusions: EF demonstrates significant effect modification by sex on the hazard ratio for all-cause and cardiac mortality. Gender also significantly modifies the relationship between EDV and coronary procedures, and ESV with heart failure. Men and women with chronic stable angina and similar EF likely do not have equivalent risk. Gender-specific echocardiographic definitions may be of incremental benefit in the identification of high-risk women.