Sex differences in central hemodynamics and their relationship to left ventricular diastolic function

Area of Science:

• Cardiovascular Physiology
• Sex Differences in Cardiovascular Disease
• Diastolic Heart Failure

Background:

• Heart failure with preserved ejection fraction (HFpEF) is more prevalent in women.
• Arterial stiffness is a key factor in heart failure development.
• Hypothesis: Arterial stiffness is more strongly associated with LV diastolic function in women than men.

Purpose of the Study:

• Investigate sex-based differences in the relationship between arterial stiffness and LV diastolic dysfunction.
• Determine if arterial stiffness contributes differently to diastolic dysfunction in men and women.

Main Methods:

• Simultaneous 2D Doppler echocardiography and radial artery tonometry in 158 subjects (79 males, 79 females).
• Participants were age-matched and free of structural heart disease or LV systolic dysfunction.
• Assessed central hemodynamics, including central pulse pressure and augmentation index.

Main Results:

• Women exhibited higher central pulse pressure and augmentation index, and lower pulse pressure amplification than men.
• Pulse pressure amplification significantly correlated with early diastolic mitral annular (Em) velocity and E/Em ratio in women (p < 0.001).
• No significant correlations were found between pulse pressure amplification and these diastolic parameters in men.

Conclusions:

• Central hemodynamics, indicative of arterial stiffness, differ between sexes despite similar peripheral pressures.
• LV diastolic function is significantly associated with arterial stiffness parameters exclusively in women.
• Earlier wave reflection effects on central pressure may increase women's susceptibility to HFpEF.