Introduction: Epidemiological studies have demons-trated that HFpEF (Heart Failure with Preserved Ejec-tion Fraction) is more frequent in women than in men. The mechanisms behind this discrepancy are incom-pletely understood. Recent focus on gender differences assessed mostly clinical and echocardiographic para-meters, with scarce data regarding gender biomarker profiling.

Objective: Our aim was to evaluate the sex differences regarding the biological profile in patients with HFpEF and how this affected their outcome.

Methods: HFpEF patients hospitalized consecutively in our clinic from January 2011 to December 2014 were screened for this study. Patients with acute coro-nary syndromes, pulmonary embolisms, and in hos-pital mortality were excluded. Clinical and laboratory parameters were recorded for all patients on admission. The patients were divided in two groups according to gender. Survival status was assessed in May 2019.

Results: Our sample consisted of 137 HFpEF patients, 67.9% female, with a mean age of 66.63 ± 11.39 years. There were no gender differences regarding comorbi-dities such as hypertension, diabetes mellitus, ische-mic heart disease or atrial fibrillation. Significant gen-der particularities were found in biomarker profiling. Women had higher NT-proBNP levels (176.00 [IQR 95.11-581.10] vs. 121.90 [IQR 33.75-532.15] pg/mL, p=0.04) and lower creatinine levels (0.80 [IQR 0.70-0.90] vs. 0.93 [IQR 0.80-1.19] mg/dL, p=0.0001), but similar hsTnT concentration (8.05[IQR 5.16-13.00] pg/ mL vs. 10.11[IQR 6.71-15.64] pg/mL, p=0.28) compa-red to men. After a mean follow-up of 6.7 years, wo-men had 21.5% mortality and men 18.2%. NT-proBNP had a better prognostic value for male patients com-pared to female patients (AUC of 0.889, 95%CI 0.754-0.984, p=0.001 vs. AUC of 0.741, 95%CI 0.597-0.886, p=0.001). Similar data was identified for hsTnT (AUC of 0.844, 95%CI 0.714-0.973, p=0.001 vs. AUC of 0.739, 95%CI 0.591-0.888, p=0.001). Neutrophil-lympho-cyte ratio was identified as a predictor for long term all-cause mortality only in women with an AUC of 0.694(95%CI 0.539-0.849), p=0.01.

Conclusions: Women with HFpEF had similar clini-cal characteristics but different biological profiles com-pared to men. Bio-profiling may be important in the-se patients for optimizing long-term management of HFpEF. The predictive value of hsTnT and NT-proBNP appeared stronger in men with HFpEF, while the neu-trophil-lymphocyte ratio carried better predictive va-lue for women with HFpEF.