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Gender difference in diastolic function in hypertension (the HyperGEN study)
Jonathan N Bella1, Vittorio Palmieri, Dalane W Kitzman
1Department of Medicine, Cornell Medical Center, New York, New York 10021, USA.
Insights
Men exhibit slower early diastolic left ventricular (LV) filling compared to women, indicated by prolonged deceleration time and isovolumic relaxation time (IVRT). This gender difference in diastolic function may offer insights into cardiovascular diseases.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Medical Research
Background:
- Gender differences in left ventricular (LV) systolic function are documented.
- Limited understanding exists regarding gender-specific differences in diastolic function.
Purpose of the Study:
- To investigate potential gender differences in diastolic function among hypertensive adults.
- To analyze Doppler echocardiographic parameters related to LV diastolic function in men and women.
Main Methods:
- Analysis of Doppler echocardiograms from 515 men and 839 women in the Hypertension Genetic Epidemiology Network (HyperGEN) study.
- Adjustment for age, race, body mass index, heart rate, blood pressure, and LV hypertrophy.
- Comparison of mitral E-wave, A-wave velocities, E/A ratio, atrial filling fraction, deceleration time, and isovolumic relaxation time (IVRT).
Main Results:
- Men had lower body mass index and heart rates, but higher systolic and diastolic blood pressure than women.
- Mitral E-wave and A-wave velocities were lower in men, while E/A ratio and atrial filling fraction were similar.
- Men showed significantly longer deceleration time and isovolumic relaxation time (IVRT), with a higher prevalence of prolonged IVRT.
Conclusions:
- Hypertensive men in this cohort demonstrated slower early diastolic LV filling compared to women.
- Prolonged deceleration time and IVRT in men suggest impaired diastolic function.
- These findings may contribute to understanding gender disparities in heart failure and cardiovascular diseases.
Abstract:
Although several studies indicate that there are gender differences in left ventricular (LV) systolic function, it remains unclear whether similar differences exist with regard to diastolic function. Accordingly, Doppler echocardiograms were analyzed in 515 male and 839 female, mostly treated (95%) hypertensive participants enrolled in the Hypertension Genetic Epidemiology Network (HyperGEN) study with no evidence of abnormal wall motion or significant valvular heart disease. There was no difference in age between genders, but after adjusting for age and race, men had lower body mass indexes (29.8 +/- 5.2 vs 32.3 +/- 7.6 kg/m(2)) and heart rates (67 +/- 12 vs 69 +/- 11 beats/min) and higher systolic and diastolic blood pressures (BP) than women (134 +/- 20 vs 130 +/- 21 and 80 +/- 11 vs 72 +/- 11 mm Hg, all p <0.001). LV mass/height(2.7) was slightly greater in women than in men (43 +/- 10 vs 42 +/- 9 g/m(2.7), p <0.05). After adjusting for age, race, systolic BP, body mass index, heart rate, and LV hypertrophy, both mitral E-wave (70 +/- 18 vs 77 +/- 19) and A-wave (74 +/- 15 vs 79 +/- 17, both p <0.001) velocities were lower in men than in women, but the mitral E/A ratio and atrial filling fraction were nearly identical in both genders. Deceleration time (221 +/- 55 vs 214 +/- 46 cm/s, p = 0.018) and isovolumic relaxation time (IVRT) were longer in men than in women (85 +/- 18 vs 81 +/- 17 cm/s, p <0.001). Prolonged IVRT was present in more men than women (14% vs 7%, p <0.05). In analyses of covariance, adjusting for age, race, systolic BP, body mass index, heart rate, and medications, male gender remained related to prolonged deceleration time and IVRT. Thus, in this population-based sample of hypertensive adults, men had evidence of slower early diastolic LV filling than women. This gender difference in diastolic function may provide insight into gender differences in congestive heart failure and other specific cardiovascular diseases.