Ultrasound measurement of left ventricular function and structural indicators and gender-age differences in type 2...

Type 2 diabetes mellitus (T2DM) induces distinct cardiac remodeling patterns, contributing to the "gender paradox" in heart failure phenotypes. However, whether aging differentially impacts left ventricular (LV) structure in males and females with T2DM remains unclear.

To characterize gender-specific LV remodeling phenotypes and investigate the independent age × gender interactions with respect to continuous LV indices in patients with T2DM.

This retrospective cross-sectional study included 253 patients with T2DM aged >35 years. Standard echocardiography was used to measure continuous LV indices, including the ejection fraction (LVEF), end-diastolic diameter (LVEDD), end-systolic diameter (LVESD), and fractional shortening (LVFS). Multivariate linear regression models fully adjusted for cardiovascular and metabolic confounders were employed to assess independent associations and interaction effects.

Significant sexual dimorphism was observed at baseline: females presented preserved systolic function (LVEF: 64.5% vs. 62.0%, P = 0.004) with concentric features, whereas males presented with significantly greater ventricular dimensions (LVEDD/LVESD, P < 0.001). Multivariate interaction analysis revealed that the age-dependent trajectories for LVEF, LVEDD, and LVFS were statistically parallel between genders (P for interaction > 0.05). However, a hypothesis-generating borderline interaction was observed for LVESD (P for interaction = 0.088), suggesting a potential divergence in end-systolic remodeling.

T2DM is associated with distinct baseline phenotypes: concentric remodeling in females versus eccentric dilation in males. While aging acts as a universal driver of structural change, its impact is largely parallel across genders. These findings support gender-stratified surveillance strategies, prioritizing the monitoring of stiffness in females and dilation in males.