The Role of Sex in Heart Failure and Transplantation

We are in the midst of an increasing epidemic of heart failure, a multifactorial syndrome with numerous etiologies in most patients and a similar prevalence in men and women. Sex differences in patients with heart failure and with heart transplantation have been described and have an important role on epidemiology, etiology, diagnosis, treatment, and prognosis. Men have a higher incidence of heart failure, but the overall prevalence rate is similar in both sexes, since women survive longer after the onset of heart failure. In fact, female sex is an independent predictor of better survival in patients with heart failure. On the other hand, women are underrepresented in heart failure clinical trials. This is, in part, due to the reason that women tend to be older when diagnosed with heart failure and more often have a preserved left ventricular ejection fraction. The extent of sex differences can partly be explained by age and left ventricular ejection fraction differences. However, other factors, including previous pregnancies, also play a role, as gestations have a strong influence on the cardiovascular system. Also, sex-specific differences in efficacy, tolerability, and safety of several pharmacologic and non-pharmacologic therapies have been described.

Sex also plays an important role in heart transplantation. Survival seems to be worse when donor/recipient sex is mismatched. But the effect of donor/recipient sex mismatch after heart transplantation is heterogeneous. Sex mismatch increases mortality after heart transplantation in male recipients. However, in female recipients, sex mismatch is not associated with poor prognosis.

The scope of the Research Topic is to present and discuss the role of sex-related factors influencing the development of heart failure and the evolution of patients with heart transplantation. Better understanding the gender aspects in heart failure and transplantation is much needed in order to design targeted strategies aimed at improving prognosis.

We are interested in manuscripts that describe the role of sex on physiopathology, epidemiology, etiology, diagnosis, pharmacologic and non-pharmacologic therapies, and prognosis. Although the Research Topic is mainly devoted to clinical studies, well-designed basic studies with clear translational implications will also be considered. We welcome Original Research, Reviews, new Methodology papers, and Systematic Reviews/meta-analyses.