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Anatol J Cardiol. 2019 Apr;21(5):242-252. doi: 10.14744/AnatolJCardiol.2019.71954.

Gender disparities in heart failure with mid-range and preserved ejection fraction: Results from APOLLON study.

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Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital; Muğla-Turkey.
Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey.
Department of Cardiology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş-Turkey.
Department of Cardiology, Mehmet Akif İnan Training and Research Hospital; Şanlıurfa-Turkey.
Department of Cardiology, Faculty of Medicine, Kafkas University; Kars-Turkey.
Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey.
Department of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital; Çorum-Turkey.
Department of Cardiology, Faculty of Medicine, Bülent Ecevit Universiy; Zonguldak-Turkey.
Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital; Kırıkkale-Turkey.
Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University; Eskişehir-Turkey.
Department of Cardiology, Yunus Emre State Hospital; Eskişehir-Turkey.



This study aimed to examine gender-based differences in epidemiology, clinical characteristics, and management of consecutive patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF).


The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is a multicenter, cross-sectional, and observational study. Consecutive patients with HFmrEF or HFpEF who were admitted to the cardiology clinics were included (NCT03026114). Herein, we performed a post-hoc analysis of data from the APOLLON trial.


The study population included 1065 (mean age of 67.1+-10.6 years, 54% women) patients from 11 sites in Turkey. Compared with men, women were older (68 years vs. 67 years, p<0.001), had higher body mass index (29 kg/m2 vs. 27 kg/m2, p<0.001), and had higher heart rate (80 bpm vs. 77.5 bpm, p<0.001). Women were more likely to have HFpEF (82% vs. 70.9%, p<0.001), and they differ from men having a higher prevalence of hypertension (78.7% vs. 73.2%, p=0.035) and atrial fibrillation (40.7% vs. 29.9%, p<0.001) but lower prevalence of coronary artery disease (29.5% vs. 54.9%, p<0.001). Women had higher N-terminal pro-B-type natriuretic peptide (691 pg/mL vs. 541 pg/mL, p=0.004), lower hemoglobin (12.7 g/dL vs. 13.8 g/dL, p<0.001), and serum ferritin (51 ng/mL vs. 64 ng/mL, p=0.001) levels, and they had worse diastolic function (E/e'=10 vs. 9, p<0.001). The main cause of heart failure (HF) in women was atrial fibrillation, while it was ischemic heart disease in men.


Clinical characteristics, laboratory findings, and etiological factors are significantly different in female and male patients with HFmrEF and HFpEF. This study offers a broad perspective for increased awareness about this patient profile in Turkey.

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