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Congestive heart failure in patients with coronary artery disease: the gender paradox
L A Mendes1, R Davidoff, L A Cupples
1Evans Memorial Department of Clinical Research, Boston Medical Center, MA 02118-2393, USA.
Insights
Women with heart failure show diastolic dysfunction despite preserved systolic function. This study reveals sex differences in myocardial dysfunction patterns, influencing heart failure prevalence in coronary artery disease patients.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Science
Background:
- Congestive heart failure (CHF) is more prevalent in women than men undergoing cardiac catheterization.
- Existing research suggests potential differences in left ventricular pressure/volume relations may explain this disparity.
Purpose of the Study:
- To investigate if differences in left ventricular pressure/volume relations contribute to the higher prevalence of CHF in women compared to men.
- To analyze clinical characteristics, ejection fraction, and end-diastolic pressure/volume in relation to sex.
Main Methods:
- Retrospective analysis of 586 women and 1081 men undergoing diagnostic coronary angiography and left ventriculography.
- Comparison of clinical data, left ventricular ejection fraction (LVEF), and end-diastolic pressure and volume between sexes.
- Multivariate analysis to identify independent predictors of CHF.
Main Results:
- Women were older and had higher rates of hypertension, diabetes, and CHF symptoms.
- Despite these factors, women exhibited better mean LVEF and less three-vessel disease.
- Women had smaller left ventricular end-diastolic volumes, particularly at higher end-diastolic pressures, indicating diastolic dysfunction.
Conclusions:
- Diastolic dysfunction is a potential mechanism for increased CHF symptoms in women with preserved systolic function.
- Female sex is an independent predictor of CHF.
- Sex influences myocardial dysfunction patterns in patients with coronary artery disease, though the underlying reasons require further investigation.
Abstract:
To determine whether the increased prevalence of congestive heart failure in women compared with men undergoing diagnostic cardiac catheterization is the result of a difference in the left ventricular pressure/volume relation, we retrospectively compared the clinical characteristics, left ventricular ejection fraction, and end-diastolic pressure and volume in 586 women and 1081 men undergoing diagnostic coronary angiography and left ventriculography. In comparison with men, women were older (63 vs 60 years; p = 0.0001) and had more hypertension (41% vs 31%; p = 0.0001), diabetes (18% vs 12%; p = 0.003), and symptoms of congestive heart failure (13% vs 10%; p = 0.05). In spite of this, women had a better mean left ventricular ejection fraction (61% vs 56%; p = 0.0001) and less prevalent three-vessel disease (23% vs 34%; p = 0.0001). Left ventricular end-diastolic volume index was smaller in women compared with men (73 vs 79 ml/m2; p = 0.0001) in spite of having similar left ventricular end-diastolic pressure. When patients were stratified according to left ventricular end-diastolic pressure, women had a significantly smaller end-diastolic volume than men did when left ventricular end-diastolic pressure was > or = 18 mm Hg (74 vs 86 ml/m2; p = 0.0001). In a multivariate analysis, female sex remained an independent predictor of congestive heart failure (odds ratio 1.72, 95% confidence interval 1.11 to 2.66, p = 0.02). This study suggests that diastolic dysfunction is one mechanism for the paradox of more frequent heart failure symptoms in spite of better preserved left ventricular systolic function in women. Sex appears to influence the pattern of myocardial dysfunction in patients with known or suspected coronary artery disease, but the basis for this observation remains speculative.