基于射血分数保留的心力衰竭可能性的氧分压梯度：关注性别差异
The Oxygen Cascade According to HFpEF Likelihood: A Focus on Sex Differences.
作者信息
Verwerft Jan, Foulkes Stephen, Bekhuis Youri, Moura-Ferreira Sara, Falter Maarten, Hoedemakers Sarah, Jasaityte Ruta, Stassen Jan, Herbots Lieven, La Gerche Andre, Haykowsky Mark J, Claessen Guido
机构信息
Department of Cardiology, JESSA Hospital, Hasselt, Belgium.
Faculty of Medicine and Life Sciences/LCRC, UHasselt, Diepenbeek, Belgium.
出版信息
JACC Adv. 2024 Jun 11;3(7):101039. doi: 10.1016/j.jacadv.2024.101039. eCollection 2024 Jul.
BACKGROUND
Women are at greater risk for heart failure with preserved ejection fraction (HFpEF).
OBJECTIVES
The aim of the study was to compare sex differences in the pathophysiology of exertional breathlessness in patients with high vs low HFpEF likelihood.
METHODS
This cohort study evaluated consecutive patients (n = 1,936) with unexplained dyspnea using cardiopulmonary exercise testing and simultaneous echocardiography and quantified peak oxygen uptake (peak VO) and its determinants. HFpEF was considered likely when the HFPEF or HFA-PEFF score was ≥6 or ≥5, respectively. Sex differences were evaluated with the Student's -test or Mann-Whitney test and determinants of exercise capacity with a multivariable linear regression.
RESULTS
The cohort included 1,963 patients (49% women and 28% [n = 555] with a high HFpEF likelihood). HFpEF likelihood did not impact the magnitude of sex differences in peak VO and its determinants. Overall, women had lower peak VO (mean difference -4.4 mL/kg/min [95% CI: -3.7 to -5.1 mL/kg/min]) secondary to a reduced O delivery (-0.5 L/min [95% CI: -0.4 to -0.6 L/min]) and less oxygen extraction (-2.9 mL/dL [95% CI: -2.5 to -3.2 mL/dL]). Reduced O delivery was due to lower hemoglobin (-1.2 g/dL [95% CI: -0.9 to -1.5 g/dL]) and smaller stroke volume (-15 mL [95% CI: -14 to -17 mL]). Women demonstrated increased mean pulmonary artery pressure/cardiac output slope (+0.5 mm Hg/L/min [95% CI: 0.3-0.7 mm Hg/L/min]) and left ventricular ejection fraction (+1% [95% CI: 1%-2%]), while they had smaller left ventricular end-diastolic volumes (-9 mL/m [95% CI: -8 to -11 mL/m]) and mass (-12 g/m [95% CI: -9 to -14 g/m]) and more often iron deficiency (55% vs 33%; < 0.001).
CONCLUSIONS
Women with unexplained dyspnea had significantly lower peak VO, regardless of HFpEF likelihood, attributed to both lower peak exercise O delivery and extraction. This suggests that physiologic sex differences, and not HFpEF likelihood, are an important factor contributing to functional limitations in females with exertional breathlessness.
背景
射血分数保留的心力衰竭（HFpEF）在女性中风险更高。
目的
本研究旨在比较高HFpEF可能性与低HFpEF可能性患者在运动性呼吸困难病理生理学方面的性别差异。
方法
这项队列研究使用心肺运动试验和同步超声心动图对连续的1936例不明原因呼吸困难患者进行评估，并对峰值摄氧量（peak VO₂）及其决定因素进行量化。当HFpEF或HFA-PEFF评分分别≥6或≥5时，则认为HFpEF可能性较大。采用学生t检验或曼-惠特尼U检验评估性别差异，并通过多变量线性回归分析运动能力的决定因素。
结果
该队列包括1963例患者（49%为女性，28% [n = 555] HFpEF可能性较高）。HFpEF可能性并未影响peak VO₂及其决定因素的性别差异幅度。总体而言，女性的peak VO₂较低（平均差异-4.4 mL/kg/min [95% CI：-3.7至-5.1 mL/kg/min]），这是由于氧输送减少（-0.5 L/min [95% CI：-0.4至-0.6 L/min]）和氧摄取减少（-2.9 mL/dL [95% CI：-2.5至-3.2 mL/dL]）所致。氧输送减少是由于血红蛋白较低（-1.2 g/dL [95% CI：-0.9至-1.5 g/dL]）和每搏输出量较小（-15 mL [95% CI：-14至-17 mL]）。女性的平均肺动脉压/心输出量斜率增加（+0.5 mmHg/L/min [95% CI：0.3 - 0.7 mmHg/L/min]），左心室射血分数增加（+1% [95% CI：1% - 2%]），而左心室舒张末期容积较小（-9 mL/m² [95% CI：-8至-11 mL/m²]），左心室质量较小（-12 g/m² [95% CI：-9至-14 g/m²]），且缺铁更为常见（55% 对33%；P < 0.001）。
结论
不明原因呼吸困难的女性，无论HFpEF可能性如何，其peak VO₂均显著较低，这归因于运动时氧输送峰值和摄取量较低。这表明生理性别差异而非HFpEF可能性是导致运动性呼吸困难女性功能受限的重要因素。
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