Abstract 12910: Relationship Between a Higher Incidence of Heart Failure with Preserved Ejection Fraction in Women and Augmentation Index Obtained at Ascending Aorta
The effect of arterial pulse wave reflection on left ventricular (LV) diastolic function may be a key issue as a cause to develop heart failure with preserved ejection fraction (HFpEF). Patients suffering from HFpEF are more common in women than in men. Accordingly, we assessed the gender differences in hemodynamic indices including the augmentation index (AIx) which is an index showing the unfavorable influence of arterial reflection wave from the lower body on LV diastolic function.
Methods We studied 75 patients (32 men and 43 women) who had neither significant coronary stenosis nor LV wall motion abnormality collected from consecutive 763 patients who underwent coronary angiography for the evaluation of chest pain. In cardiac catheterization, the LV relaxation time constant (Tp) was computed from the LV pressure-dP/dt relation (phase loop) which was obtained using a catheter-tipped micromanometer. From the recorded aortic pressure waveforms, the AIx was calculated as augmented pressure divided by pulse pressure.
Results No significant difference was found in age, mean blood pressure, heart rate, or incidences of diabetes mellitus or dyslipidemia between men and women. No significant difference was observed in LV ejection fraction (72.1±4.9 vs 72.3±4.7%, p=0.82), or LV end-diastolic pressure (13.4±4.2 vs 13.0±4.3 mm Hg; p=0.69) between the gender. The Tp was significantly longer in women (73.6±28.0 vs 62.2±14.4 ms, p=0.04). As expected, women had significantly shorter height than men. The AIx was significantly greater in women than in men (45.7±14.0 vs 37.9±13.9%, p=0.02). The AIx significantly and positively correlated with age (r=0.34, p=0.003) and Tp (r=0.24, p=0.05). In contrast, it significantly and negatively correlated with height (r=-0.35, p=0.003). The AIx is also significantly correlated with plasma BNP level (r=0.31, p=0.03). BNP level was significantly higher in women than in men (23.4 [IQR, 15.3-43.4] vs 14.1 [IQR, 7.9-28.2] pg/mL, p=0.02).
Conclusion The AIx is negatively correlated with the height of patients. The increased AIx has a significant association with increased plasma BNP level and with prolonged Tp. The higher AIx observed in women with shorter height may be one of the causes of the increased prevalence of HFpEF in women.
- © 2011 by American Heart Association, Inc.