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TP 13 Gender Differences in Heart Failure after Coronary Artery Bypass Graft Surgery

Background

Subproject 13 was initiated and launched based on the results of a large retrospective study at the German Heart Institute Berlin, which revealed significant differences in progress after aortocoronary bypass surgery to the disadvantage of women, whereby no significant gender differences in the influence of numerous clinical parameters were found. This prospective study examines the influence of heart failure, hormone status and psychosocial factors on the result after ACVB surgery.

Clinical symptoms of systolic heart failure were more frequent in women in the retrospective analysis. In associated studies of the German Heart Institute Berlin, biopsies taken during surgery revealed indications of gender-specific differences in mechanisms for adaptation to ischemia, which could be the cause of diastolic dysfunction.

Objective

Thus, the primary goals of the subproject, in cooperation with other subprojects, are the investigations of

  • gender-specific factors which have a substantial influence on cardiovascular mortality and morbidity within the first year after ACVB surgery, whereby the influence of systolic and diastolic functional limitations in women play a main role,
  • and the influence of hormonal and psychosocial factors on progress after ACVB surgery.

Fundamental information for the improvement of management of the disease should be gained from this data. Knowledge and targeted monitoring of the risk factors for women as well as men saves resources and facilitates better intervention planning. This applies to the planning of surgical interventions as well as interventions in the hormone status and psychosocial care. Moreover, the following molecular and genetic analyses facilitate the discovery and targeted use of new or existing drug strategies.

Main result

Women and men undergoing ACVB surgery show important differences regarding their baseline characteristics (as age and risk factor profile) but also in terms of prognosis (post-operative mortality risk). Important – mainly psychosocial  – gender-specific risk indicators and risk factors were identified contributing to the higher early post-operative mortality risk in women after ACVB surgery.

Publications

  • Dunkel A et al. Predictors of preoperative depressive risk in patients undergoing coronary artery bypass graft surgery. Clin Res Cardiol. 2009; 98:643-50.
  • Kendel F et al. Gender differences in health-related quality of life after coronary bypass surgery: Results from a 1-year follow-up in propensity- matched men and women. Psychosom Med. 2011;73:280-5.
  • Kendel F et al. Predictive relationship between depression and physical functioning after coronary surgery. Arch Intern Med. 2010;170:1717-21.

Perspective

The gender-specific research constitutes a cross-sectional element of basically all analyses within the competence network heart failure. Gender-specfic research questions are continuously being followed in cooperation within various subprojects that coordinate long-term follow-up studies.

Contact

Prof. Dr. Vera Regitz-Zagrosek
Charité – Universitätsmedizin Berlin
Institut für Geschlechterforschung in der Medizin
Tel.: +49 (0)30 450525172
E-Mail: ed.etirahcnull@kesorgaz-ztiger.arev