Abstract 13063: Sex Specific Differences in Ventricular Function in Health and Disease
Background: Heart failure (HF) with preserved ejection fraction (HFpEF) is the predominant form of HF in women, while HF with reduced EF (HFrEF) is more common in men. Studies in healthy animals and humans suggest higher left ventricular (LV) systolic stiffness (elastance; Ees) in women. However, body size related differences in LV size, contractility and passive stiffening each affect Ees and may account for sex-specific differences. Age and disease may alter remodeling and contractility and thus, sex-specific differences.
Hypothesis: Accounting for body size, contractility and age, healthy (CONTROL) women have higher Ees than men and these sex differences persist in the presence of hypertensive heart disease without HF (HTN) or HFpEF.
Methods: Age and sex matched CONTROL (n=136), HTN (n=272) and HFpEF (n=340) cohorts from Olmsted County, MN with echocardiography were identified. Allometric scaling powers were used to adjust LV end-diastolic volume for sex related body size differences (EDVi; EDV/height1.4). Ejection fraction was used as an index of contractility.
Results: Overall, as expected, Ees was directly related to EF (r=0.610, p≤0.0001) and inversely related to EDVi (r=-0.629. p≤0.0001). In CONTROL (Men 62.4±5.4%; Women 65.1±6.1%, p=0.006), HTN (Men 63.3±5.4%; Women 65.6±5.7%, p=0.001) and HFpEF (Men 59.4±6.3%; Women 63.5±6.6%, p≤0.0001), EF was higher in women than in men. Adjusting for age, EDVi and EF, Ees was higher in women than in men in CONTROL (parameter estimate (PE) 0.417 mmHg/ml, standard error (STE) 0.108, p≤0.002), HTN (PE 0.460 mmHg/ml, STE 0.078, p≤0.0001) and HFpEF (PE 0.430 mmHg/ml, STE 0.069, p≤0.0001) suggesting greater passive LV stiffening in women. Consistent with this, in CONTROL (12±5 vs 10±5, p=0.09), HTN (14±7 vs 12±4, p=0.004) and HFpEF (19±9 vs 16±8, p=0.009), women had higher LV filling pressures (mitral E/e’) than men. Adjusting for age, EDVi and EF, Ees was higher in HTN (p=0.004) and HFpEF (p=0.01) than CONTROL in women, but did not vary between groups in men (p=0.20 for both).
Conclusion: These data provide evidence of enhanced contractility but also increased passive LV stiffening in women as compared to men in health and disease and contribute to our understanding of sex-specific differences in HF pathophysiology.
- © 2013 by American Heart Association, Inc.