ArticleJournal of the American Heart Association2019
Impact of Sex on Ventricular-Vascular Stiffness and Long-Term Outcomes in Heart Failure With Preserved Ejection Fraction: TOPCAT Trial Substudy.
Article in Journal of the American Heart Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00094302 (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist), which is not on this map. Cited by 17 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT)
Who cites it
17 citing papers in PubMed.
- Sex differences in vascular function among individuals with heart failure: a systematic review.International journal of cardiology. Heart & vasculature · 2026Review
- Sex and Gender Aspects in New-Onset Heart Failure Prognosis: A Review of Recent Advances.Current heart failure reports · 2025Review
- Sex Differences in 90-Day Readmission and Mortality Trends in Heart Failure With Preserved Ejection Fraction: Insights From the National Readmissions Database.International journal of heart failure · 2025Article
- Sex-specific molecular drivers of cardiac fibrosis in aging hearts.GeroScience · 2025Article
- The moderating effect of fluid overload on the relationship between the augmentation index and left ventricular diastolic function in patients with CKD.Scientific reports · 2024Article
- Determination of the Level of Cardiovascular Risk in 172,282 Spanish Working Women.Diagnostics (Basel, Switzerland) · 2023Article
- Renal Denervation Helps Preserve the Ejection Fraction by Preserving Endocardial-Endothelial Function during Heart Failure.International journal of molecular sciences · 2023Article
- Sex Differences in Adiposity and Cardiovascular Diseases.International journal of molecular sciences · 2022Review
- The impact of sex on blood pressure and anthropometry trajectories from early adulthood in a Nigerian population: insights into women's cardiovascular disease risk across the lifespan.BMC women's health · 2022Article
- Comprehensive Physiological Modeling Provides Novel Insights Into Heart Failure With Preserved Ejection Fraction Physiology.Journal of the American Heart Association · 2021Article
- Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction.Cardiovascular diabetology · 2021Article
- Sex Differences in Molecular Mechanisms of Cardiovascular Aging.Frontiers in aging · 2021Review
- Sex Differences in Characteristics and Outcomes in Elderly Heart Failure Patients With Preserved Ejection Fraction: AFrontiers in cardiovascular medicine · 2021Article
- Potential use of ubiquinol and d-ribose in patients with heart failure with preserved ejection fraction.Annals of medicine and surgery (2012) · 2020Review
- Sex and Gender Differences in Heart Failure.International journal of heart failure · 2020Review
- Obesity and cardiovascular disease in women.International journal of obesity (2005) · 2020Review
- Impact of Sex on Ventricular-Vascular Stiffness and Long-Term Outcomes in Heart Failure With Preserved Ejection Fraction: TOPCAT Trial Substudy.Journal of the American Heart Association · 2019Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background Women have higher vascular stiffness with aging. The aim of this study was to characterize sex differences in vascular and ventricular structure and function, and to investigate the impact on the primary outcome in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial). Methods and Results Data from the Americas cohort of the TOPCAT trial were analyzed. Patients with echocardiography (n=654) were compared according to sex, and achievement of the primary end point (a composite of death from cardiovascular causes and heart failure hospitalization) assessed. Echocardiography revealed higher arterial, systolic, and diastolic ventricular elastance and worse ventricular-vascular coupling in women. Women had better overall survival and heart failure hospitalization outcomes (hazard ratio 0.74, 95% CI 0.57-0.98, P=0.034), however, determinants of achievement of the primary outcome differed between the sexes. Pulse pressure was a key determinant of outcome in women (hazard ratio 1.04, 95% CI 1-1.09, P=0.034) whereas in men heart rate (hazard ratio 1.61, 95% CI 1.02-2.52 per 10 mm Hg increase, P=0.04) and B-type natriuretic peptide (hazard ratio 1.01, 95% CI 1-1.02 per 10 ng/mL increase P=0.02) were associated with poorer outcome. Conclusions Outcomes in patients with heart failure with preserved ejection fraction appear to be differentially influenced by key physiological factors that vary according to sex. In women, ventricular-vascular stiffening was the most significant determinant of outcome, whereas in men overall survival was influenced by heart rate and B-type natriuretic peptide; this highlights key sex differences in the pathophysiology and outcomes of heart failure with preserved ejection fraction and warrants further exploration. Clinical Trial Registration URL: https://clinicaltrials.gov . Unique identifier: NCT00094302.
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