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0,949 Terre

0,533 Terre. 0,949 Terre. Cardiologie au féminin Mars ou Venus. L’insuffisance cardiaque. Mars est désarmé par Venus et les grâces Jacques Louis David. Epidemiologie. 11327 sur 6 semaines et plus de 150 centres. FEVG <40%: Hommes: 51 % vs Femmes: 28 %.

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0,949 Terre

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  1. 0,533 Terre 0,949 Terre

  2. Cardiologie au féminin Mars ou Venus L’insuffisance cardiaque Mars est désarmé par Venus et les grâcesJacques Louis David

  3. Epidemiologie

  4. 11327 sur 6 semaines et plus de 150 centres FEVG <40%: Hommes: 51 % vs Femmes: 28 % Cleland European Heart Journal (2003) 24, 442–463

  5. 11,327 patients. 47% de femmes. 51 % de femmes et 30% d’hommes ont plus de 75 ans. 53 % des patients ont un diagnostic d’IC avant l’hospitalisation (index). >90% vont bénéficier de: ECG, X-ray, HB, Iono (cf reco de l’ESC) FEVG échocardiographique dans 84% des cas FEVG mesurée seulement chez 57% des hommes 41% des femmes FEVG normale: 45% des femmes 22% des hommes Après 12 semaines 24% vont être réadmis pour IC 13.5% vont décéder. Cleland European Heart Journal (2003) 24, 442–463

  6. Les traitements de l’insuffisance cardiaque Cas des IEC, Beta -

  7. IEC/b- the CONSENSUS-1 study showed a statistically significant reduction in mortality with enalapril in men but not in women. Whereas men achieved a 51% reduction in 6-month mortality (P,0.001), women achieved only a 6% reduction (P=NS). The SOLVD investigators found that men and women treated with enalapril experienced a reduction in mortality and hospitalizations, although this effect was less for women. Sous représentation des femmes+ Design des études.., Pas prévues pour démontrer un bénéfice en terme de mortalité , dans le sous groupe feminin

  8. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. . Faible nombre d’événements OR et 95% CI Garg R, Yusuf S : JAMA. 1995;273:1450–145

  9. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Mortalité totale Sous représentatio dans les études? Bénéfice inférieur des IEC? Effet propre, différence de structure , de fonction

  10. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Mortalité totale et hospitalisation

  11. b- Merit HF, CIBIS, Copernicus

  12. COPERNICUS % hommes, % de CMI,et FEVG !!!!

  13. COPERNICUS

  14. COPERNICUS DEATH DEATH and HOSPIT

  15. MERIT-HF - Entry Characteristics Meto CR/XL Placebo Mean age(years) 64 64 Male sex(%) 77 78 NYHA class II(%) 41 41 III(%) 56 55 IV(%) 3.5 3.8 Ejection fraction 0.280.28 The MERIT-HF Study Group, Lancet 1999;353:2001-07

  16. Total Mortality Per cent 20 Placebo 15 p = 0.0062 (adjusted) p = 0.00009 (nominal) Metoprolol CR/XL 10 Risk reduction = 34% 5 RR for female gender: NS 0 0 3 6 9 12 15 18 21 Months of follow-up The MERIT-HF Study Group, Lancet 1999;353:2001-07

  17. Groupe placebo de Merit HF: après ajustement le meilleur pronostic des femmes persiste Plus faible proportion de CMI, plus de CMD primitive

  18. CIBIS 2 The estimated annual mortality rate was 8·8% in the bisoprolol group and 13·2% in the placebo group (hazard ratio 0·66 [95% CI 0·54–0·81

  19. Sex differences in the prognosis of congestive heart failure: results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Simon T, Mary-Krause M, Funck-Brentano C et al Age, Pas, BBG,CMI-, tabac Circulation. 2001;103:375–380.

  20. Sex differences in the prognosis of congestive heart failure: results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Simon T, Mary-Krause M, Funck-Brentano C et al FU: 1,3y CMD/CMI Female sex in CIBIS-II also significantly and independently predicted improved survival in patients with heart failure, independent both of -blocker treatment and of baseline clinical profile. Circulation. 2001;103:375–380.

  21. Sex differences in the prognosis of congestive heart failure: results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Simon T, Mary-Krause M, Funck-Brentano C et al Sex et traitement sont des prédicteurs indpendants Circulation. 2001;103:375–380.

  22. Gender Differences in Survival in Advanced Heart Failure Insights From the FIRST Study Kirkwood F. Adams, C

  23. Metoprolol CR/XL in female patients with heart failure: analysis of the experience in MERIT-HF. The 23% of women enrolled in MERIT-HF was the only subgroup for whom mortality benefit was not demonstrated. Circulation. 2002;105;1585–1591.

  24. Gender Differences in Survival in Advanced Heart Failure Insights From the FIRST Study Background—Previous natural history studies in broad populations of heart failure patients have associated female gender with improved survival, particularly in patients with a non ischemic etiology of ventricular dysfunction. This study investigates whether a similar survival advantage for women would be evident among patients with advanced heart failure. Kirkwood F. Adams, C Circulation. 1999;99:1816-1821.

  25. Predictors of Sudden Cardiac Death and Appropriate Shockin the Comparison of Medical Therapy, Pacing, andDefibrillation in Heart Failure (COMPANION) Trial + higher benefit of CRT Circulation. 2006;114:2766-27

  26. MERIT-HF, PRAISE, PRAISE-2, PROMISE, and VEST EF Male: 23.6% Female: 23.2% , AGE 60.2 ans Frazier. J Am Coll Cardiol 2007;49:1450–8

  27. La prise en charge

  28. The EuroHeart Failure Survey European Heart Journal (2003) 24, 464-474

  29. The EuroHeart Failure Survey Being male: More Beta – More anti thrombotic agents More spironolactone More aspirin More ACE Less Ca - European Heart Journal (2003) 24, 464-474

  30. Influence of gender of physicians and patients onguideline-recommended treatment of chronicheart failure in a cross-sectional studyMagnus Baumhackel

  31. Influence of gender of physicians and patients onguideline-recommended treatment of chronicheart failure in a cross-sectional studyMagnus Baumhackel Patient femme traité par un homme Patient homme traité par une femme

  32. Elements fondamentaux de la différence Adaptation to pressure overload different (case of AS) More efficient myocardial fn in HF, HFPEF Gender difference in activation of SRAA Gender and fibroses related to hypertrphy Estrogens and vasodilatation Apoptosis

  33. Plasma Brain Natriuretic PeptideConcentration: Impact of Age and GenderMargaret M. Redfield J Am Coll Cardiol 2002;40:976–82

  34. Plasma Brain Natriuretic PeptideConcentration: Impact of Age and GenderMargaret M. Redfield HRT= hormonothérapie substitutive J Am Coll Cardiol 2002;40:976–82

  35. Gender Differences and Normal Left VentricularAnatomy in an Adult Population Free of HypertensionA Cardiovascular Magnetic Resonance Studyof the Framingham Heart Study Offspring Cohort Autres facteurs? Salton. J Am Coll Cardiol 2002;39:1055–60

  36. Role of Gender in Heart Failure with Normal Left Ventricular Ejection Fraction Vera Regitz-Zagrosek,Progress in Cardiovascular Diseases, Vol. 49, No. 4, 2007: pp 241-251

  37. Effects of Age, Gender, and Left Ventricular Mass onSeptal Mitral Annulus Velocity (E=) and the Ratio ofTransmitral Early Peak Velocity to E= (E/E=) Am J Cardiol 2005;95:1020–1023

  38. Hypertrophic Remodeling: Gender Differences in the Early Response to Left Ventricular Pressure Overload female male female male Bonne adaptation au stress barométrique Douglas J Am Coll Cardiol 1998;32:1118–25

  39. Peptides 30 (2009) 2309–2315

  40. Vera Regitz-Zagrosek,Progress in Cardiovascular Diseases, Vol. 49, No. 4, 2007: pp 241-251 Kirkwood F. Adams, C Estrogen signaling in the cardiovascular system. Estrogen (E2) can activate a cytosolic protein-bound ER that then shuttles into the nucleus and activates gene transcription at an estrogen responsive element (ERE) at AP1or SP1 elements. Caveolae-associated ER may stimulate Src, PI3kinase, AKT, and GSK3b b b leading to NOS activation and NO production. Estrogen receptor a a a can also interact with the MAPkinase pathway, can modulate calcium influx at the L-type calcium channel, or calcium handling at the sarcoplasmatic reticulum. Growth factors (GFs) can activate ERs in a ligand-independent manner.

  41. Pour résumer • Le pronostic de l’IC à FEVG basse est meilleur chez la femme (non ischémique). • La représentation féminine dans l’ins cardiaque à FEVG préservée est plus importante … mais multifactoriel. • Chez la femme, en cas de surcharge barométrique, nette HVG, réduction de la taille de la cavité, importante réduction du stress pariétal et efficience myocardique accrue. • Chez l’homme évolution fibrosante plus importante. La composition de l’ »hypertrophie » est différente. • La réduction de l’HVG s’associe à une composition myocardique également différente. • Les récepteurs estrogéniques jouent un rôle prépondérant des cette adaptation

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