Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennesee.
J Card Fail. 2022 Feb;28(2):202-211. doi: 10.1016/j.cardfail.2021.10.019. Epub 2021 Dec 23.
Mechanisms underlying sex differences in heart failure with preserved ejection fraction (HFpEF) are poorly understood. We sought to examine sex differences in measures of arterial stiffness and the association of arterial stiffness measures with left ventricular hemodynamic responses to exercise in men and women.
We studied 83 men (mean age 62 years) and 107 women (mean age 59 years) with HFpEF who underwent cardiopulmonary exercise testing with invasive hemodynamic monitoring and arterial stiffness measurement (augmentation pressure [AP], augmentation index [AIx], and aortic pulse pressure [AoPP]). Sex differences were compared using multivariable linear regression. We examined the association of arterial stiffness with abnormal left ventricular diastolic response to exercise, defined as a rise in pulmonary capillary wedge pressure relative to cardiac output (∆PCWP/∆CO) ≥ 2 mmHg/L/min by using logistic regression models.
Women with HFpEF had increased arterial stiffness compared with men. AP was nearly 10 mmHg higher, and AIx was more than 10% higher in women compared with men (P < 0.0001 for both). Arterial stiffness measures were associated with a greater pulmonary capillary wedge pressure response to exercise, particularly among women. A 1-standard deviation higher AP was associated with > 3-fold increased odds of abnormal diastolic exercise response (AP: OR 3.16, 95% CI 1.34-7.42; P = 0.008 [women] vs OR 2.07, 95% CI 0.95-5.49; P = 0.15 [men]) with similar findings for AIx and AoPP.
Arterial stiffness measures are significantly higher in women with HFpEF than in men and are associated with abnormally steep increases in pulmonary capillary wedge pressure with exercise, particularly in women. Arterial stiffness may preferentially contribute to abnormal diastolic function during exercise in women with HFpEF compared with men.
射血分数保留的心衰（HFpEF）中性别差异的机制尚不清楚。我们旨在研究男性和女性中动脉僵硬度指标的性别差异，并探讨动脉僵硬度指标与左心室对运动的血液动力学反应之间的关系。
我们研究了 83 名男性（平均年龄 62 岁）和 107 名女性（平均年龄 59 岁），这些患者均患有 HFpEF，他们接受了心肺运动测试，同时进行了有创血液动力学监测和动脉僵硬度测量（增强压 [AP]、增强指数 [AIx] 和主动脉脉搏压 [AoPP]）。使用多变量线性回归比较了性别差异。我们使用逻辑回归模型检查了动脉僵硬度与异常左心室舒张期对运动的反应之间的关系，异常左心室舒张期对运动的反应定义为肺毛细血管楔压相对于心输出量的升高（∆PCWP/∆CO）≥2mmHg/L/min。
HFpEF 女性的动脉僵硬度高于男性。AP 高近 10mmHg，AIx 高 10%以上（两者均 P＜0.0001）。动脉僵硬度指标与运动时肺毛细血管楔压的反应呈正相关，尤其是在女性中。AP 每增加 1 个标准差，异常舒张运动反应的可能性增加 3 倍以上（AP：OR 3.16，95%CI 1.34-7.42；P=0.008[女性]与 OR 2.07，95%CI 0.95-5.49；P=0.15[男性]），AIx 和 AoPP 也有类似的发现。
HFpEF 女性的动脉僵硬度指标明显高于男性，并且与运动时肺毛细血管楔压异常陡峭增加相关，尤其是在女性中。与男性相比，HFpEF 女性的动脉僵硬度可能优先导致运动时舒张功能异常。
