Sex differences in acute heart failure: Clinical presentation, imaging findings, and short-term recovery

Background Sex differences in chronic heart failure are well established, but corresponding differences in acute heart failure (AHF), particularly in multimodal imaging findings and short-term recovery, remain incompletely characterized. Methods In this prospective observational study, 567 adults hospitalized with AHF underwent clinical assessment, laboratory testing, transthoracic echocardiography, and lung ultrasound during the early in-hospital phase (median 2 days after admission) and 1–3 months after discharge. The primary endpoint was the composite of all-cause mortality or heart failure readmission within 180 days. Results Among 567 patients (mean age 78.2±11.6 years), 248 (43.7%) were female. Females were older and more frequently had atrial fibrillation and hypertension, whereas males more frequently had dyslipidemia and ischemic heart disease. Females more frequently presented with palpitations and peripheral edema, whereas males more frequently reported chest pain. During the early in-hospital assessment, females had higher left ventricular ejection fraction (38% vs. 35%, p<0.001), higher absolute global longitudinal strain (10.5±4.7% vs. 9.7±4.4%, p=0.04), lower left ventricular mass index (113 vs. 136 g/m2, p<0.001), and higher relative wall thickness (0.51 vs. 0.47, p=0.002). Males had a higher lung ultrasound B-line count (5 [1–12] vs. 2 [0–9], p=0.003). Among patients completing follow-up, improvements in cardiac function, congestion, and NT-proBNP were similar between sexes. No statistically significant sex differences were observed in the 180-day composite outcome. Conclusions Females and males hospitalized with AHF exhibited distinct clinical presentation and imaging profiles during the early in-hospital assessment. Among patients completing follow-up, short-term recovery was similar between sexes, with no statistically significant sex differences in 180-day clinical outcomes.