Abstract Body (Do not enter title and authors here): Background: Sex differences in physiology and presentation have been well established across the heart failure (HF) spectrum. Sex differences in presentations of acute decompensated heart failure (ADHF) have not yet been well described.

Hypothesis: Women hospitalized with ADHF present with different hemodynamic profiles than men.

Methods. Through the NHLBI BioLINCC resource, we obtained publicly available data via the NHLBI BioLINCC resource for the ESCAPE trial, which evaluated the potential benefit of pulmonary artery catheterization (PAC) in managing ADHF. We compared \ characteristics at enrollment between men and women with respect to symptoms, physical exam, biomarkers, imaging, and hemodynamics.

Results: Women were more likely than men to be non-white (52% vs. 36%, p=0.02) with a non-ischemic etiology (69% vs. 44%, p<0.001). Women had a worse Minnesota Living with Heart Failure physical subscore (34.6±5 vs. 32.6±6.7, p=0.008) and more physical signs of congestion (10.7±2.3 and 10.1±2.5, p=0.03). On PAC, right atrial pressure (11.1±5.8 v. 13.0±5.8 mm Hg, p=0.08), mean PA pressure (35±10 v. 38±11 mm Hg, p=0.03), pulmonary capillary wedge (22±8 vs. 25±8 mm Hg,p=0.07) were all significantly lower or trended lower in women despite similar cardiac index, and mixed venous oxygen saturations between men and women (Image 1). Echocardiographic correlates including right and left atrial area, mitral inflow deceleration time (161±74 vs. 138±50 ms, p=0.04) and estimated right atrial pressure (40% vs. 60% > 15 mm Hg, p=0.02) were concordant with PAC findings and consistent with lower intracardiac filling pressures in women (Image 2).

Conclusions: Despite similar physical and symptomatic features on presentation, women with ADHF appear to have lower intracardiac filling pressures. This suggests that women may develop increasing symptoms with less absolute fluid retention, which could have implications for ambulatory monitoring of HF for impending decompensation.