Sex-specific analysis of cardiac and non-cardiac factors associated with exercise tolerance in heart failure patients
https://doi.org/10.15829/1728-8800-2025-4472
EDN: KYTQJF
Abstract
Aim. To determine cardiac and non-cardiac factors associated with exercise tolerance in male and female patients with heart failure (HF).
Material and methods. This retrospective analysis included 498 patients (198 women) with HF from the cohort of the multicenter study "Prevalence of Iron Deficiency in Patients with Heart Failure in the Russian Federation." The relationship between anthropometric, clinical, and laboratory parameters, as well as self-rated health and mental status using the EuroQol Group EQ-5D questionnaire, and exercise tolerance (6-minute walk test (6MWT)) was assessed. Multiple linear regression analysis, including models with centered variables, was used to determine the association of various factors with the 6MWT distance.
Results. Men with a 6MWT distance in the lower tertile were older, had a lower left ventricular (LV) ejection fraction (EF), and higher N-terminal pro-brain natriuretic peptide (NT-proBNP). They were more likely to have anemia and iron metabolism disorders. In the combined model, age, LVEF, NT-proBNP level, red blood cell (RBC) volume deviation, the transferrin saturation, moderate and severe anxiety/depression self-assessment, and female sex were significantly associated with the 6MWT distance. The model’s explained variance was 31%. In models constructed separately for men and women, age, LVEF, RBC volume deviation, NT-proBNP level, and self-rated anxiety/depression were significantly associated with 6MWT distance in men while in women — only age and self-rated anxiety/depression. In models with centered variables, a significant interaction was found only for moderate depression/anxiety in men, which was associated with a decrease in distance of 82 m, and only a 21 m decrease in women.
Conclusion. All factors, except self-reported mental status, were associated with only minimal changes in 6MWT distance. No clear statistically confirmed interaction with sex was found for NT-proBNP and LVEF. However, plot analysis suggests a more pronounced association between these indicators and 6MWT distance in men.
Keywords
iron deficiency,
heart failure,
6-minute walk test,
transferrin saturation,
anxiety,
depression,
men,
women
Supporting agencies: The work was carried out as part of a state assignment from Lomonosov Moscow State University. The authors would like to thank the team of the study "Prevalence of iron deficiency in patients with chronic heart failure in the Russian Federation": Kobalava Zh.D., Karapetyan L.V., Galochkin S.A., Kazakhmedov E.R., Lapshin A.A., Garganeeva A.A., Kuzheleva E.A., Efremushkina A.A., Kiseleva E.V., Barbarash O.L., Pecherina T.B., Galyavich A.S., Galeeva Z.M., Baleeva L.V., Koziolova N.A., Veklich A.S., Duplyakov D.V., Maksimova M.N., Yakushin S.S., Smirnova E.A., Sedykh E.V., Shaposhnik I.I., Makarova N.A., Zemlyanukhina A.A., Skibitsky V.V., Fendrikova A.V., Skibitsky A.V., Spyropoulos N.A., Seredenina E.M., Orlova Ya.A., Yeruslanova K.A., Kotovskaya Yu.V., Tkacheva O.N.
About the Authors
Yu. L. Begrambekova
Lomonosov Moscow State University
Russian Federation
Russian Federation
Leninskiye Gory, 1, Moscow, 119234
Yu. V. Mareev
University of Glasgow
United Kingdom
United Kingdom
University Avenue, Glasgow, G12 8QQ, Scotland
V. Yu. Mareev
Lomonosov Moscow State University
Russian Federation
Russian Federation
Leninskiye Gory, 1, Moscow, 119234
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Supplementary files
What is already known about the subject?
- Reduced functional capacity and exercise tolerance in patients with heart failure is determined by a combination of cardiac and non-cardiac factors.
What might this study add?
- Separately analysis for men and women showed that only age and severe anxiety/depression according to the EuroQol Group EQ 5D demonstrated an independent association with 6-minute walk test distance in women.
- In men, left ventricular ejection fraction, red blood cell volume deviation and N-terminal pro-brain natriuretic peptide also demonstrated an independent association.
- A sex-modifying effect on 6-minute walk distance was demonstrated only for self-assessed mental state in men, in whom even moderate psychological impairment was associated with a distance reduction.
Review
For citations:
Begrambekova Yu.L., Mareev Yu.V., Mareev V.Yu. Sex-specific analysis of cardiac and non-cardiac factors associated with exercise tolerance in heart failure patients. Cardiovascular Therapy and Prevention. 2025;24(10):4472. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4472. EDN: KYTQJF
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