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Sex differences in left ventricular afterload and diastolic function are independent from the aortic size

Hidemi Sorimachi1, Koji Kurosawa1, Kuniko Yoshida1

  • 1Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.

Plos One
|April 5, 2019
PubMed

Insights

Women experience worse left ventricular relaxation than men, contributing to heart failure with preserved ejection fraction (HFPEF). This disparity persists even after accounting for aortic size, highlighting key sex differences in cardiovascular mechanics.

Area of Science:

  • Cardiovascular physiology
  • Medical research
  • Sex-based differences in health

Background:

  • Heart failure with preserved ejection fraction (HFPEF) disproportionately affects women.
  • Arterial stiffness and increased afterload contribute to left ventricular (LV) diastolic dysfunction in HFPEF.
  • Previous studies used body surface area to estimate aortic size, potentially confounding sex-based analyses.

Purpose of the Study:

  • To investigate sex differences in the relationship between LV function and afterload in elderly patients with preserved ejection fraction (EF).
  • To evaluate if aortic size influences the observed sex disparities in LV diastolic function and afterload.

Main Methods:

  • Comprehensive hemodynamic evaluation of 443 elderly patients (169 women) with preserved EF using echocardiography and CT.
  • Linear regression analyses to assess sex contributions to LV function and its interaction with afterload.
  • Adjustment for CT-derived aortic length and volume to account for variations in aortic size.

Main Results:

  • Women exhibited greater arterial elastance and lower arterial compliance than men, despite similar blood pressures.
  • Significant sex differences were found in the associations between LV afterload and relaxation (mitral e'), and in left atrial (LA) emptying fraction.
  • These sex disparities remained significant after adjusting for aortic length and volume.

Conclusions:

  • Women demonstrate impaired LV relaxation compared to men when subjected to similar afterload levels.
  • Aortic size does not fully explain the observed sex differences in LV diastolic function and afterload.
  • These findings underscore critical sex-based differences in cardiovascular mechanics relevant to HFPEF.
Abstract

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