Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea.
Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea.
PLoS One. 2024 Nov 19;19(11):e0313677. doi: 10.1371/journal.pone.0313677. eCollection 2024.
Increased arterial stiffness elevates aortic load, which can have adverse impacts on left ventricular (LV) function and contribute to the onset of heart failure. This impact is known to be more pronounced in women. Optimal coordination between ventricular contraction and the arterial system is required to maintain efficient cardiac function. This study aimed to investigate sex differences in the impact of ventricular-arterial coupling (VAC) on LV function in patients with hypertension at rest and after handgrip exercise. Echocardiographic indexes of LV volumes, systolic function, and diastolic function were obtained in the usual way. Effective arterial elastance (EA) and index (EAI) were calculated from stroke volume measured using LV outflow waveform. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. Central aortic pressure waveform was recorded using the applanation tonometry. Characteristic impedance (Zc) of aortic root and reflection magnitude (RM) was calculated after Fourier transformation of both aortic pressure and flow waveforms. Sixty-four patients (31 women and 33 men) with hypertension were enrolled. Women showed higher ELVI (1.33±0.34 vs. 1.10±0.29 mmHg/ml∙m2, P = 0.004) and EAI (1.14±0.25 vs. 0.93±0.26 mmHg/ml∙m2, P = 0.001), but VAC was not different (women: 0.88±0.17 vs. men: 0.85±0.11, P = 0.431). Zc and RM were not different between women and men. After handgrip exercise, an increase in ELVI (P = 0.021) and a decrease in VAC (P = 0.035) were observed specifically in men, with no corresponding changes noted in women. In women, VAC was significantly associated with E' velocity (beta -0.344, P = 0.029) and left ventricular global longitudinal strain (beta 0.470, P = 0.012) after adjustment, but in men, no association was found. Hypertensive women demonstrated greater stiffness in both the left ventricle and arterial systems, along with impaired LV contractile reserve in response to handgrip exercise, as compared to men. The ventricular-arterial mismatch had a notable impact on LV diastolic and systolic dysfunction only in women, but not in men.
动脉僵硬度的增加会增加主动脉负荷，这可能对左心室 (LV) 功能产生不利影响，并导致心力衰竭的发生。这种影响在女性中更为明显。为了维持有效的心脏功能，心室收缩和动脉系统之间需要最佳的协调性。本研究旨在探讨在静息和握力运动后，心室-动脉偶联 (VAC) 对高血压患者 LV 功能的性别差异。采用常规方法获得 LV 容积、收缩功能和舒张功能的超声心动图指标。从 LV 流出道波形测量的每搏量计算有效动脉弹性 (EA) 和指数 (EAI)。使用单次搏动法获得有效 LV 收缩末期弹性 (ELV) 和指数 (ELVI)。使用平板测压法记录中心主动脉压力波形。对主动脉压力和流量波形进行傅立叶变换后，计算主动脉根部特征阻抗 (Zc) 和反射幅度 (RM)。共纳入 64 例高血压患者（31 名女性和 33 名男性）。女性的 ELVI（1.33±0.34 比 1.10±0.29 mmHg/ml∙m2，P=0.004）和 EAI（1.14±0.25 比 0.93±0.26 mmHg/ml∙m2，P=0.001）更高，但 VAC 无差异（女性：0.88±0.17 比男性：0.85±0.11，P=0.431）。女性和男性之间 Zc 和 RM 无差异。握力运动后，仅男性的 ELVI 增加（P=0.021），VAC 降低（P=0.035），而女性则没有相应的变化。在女性中，VAC 与 E' 速度（beta -0.344，P=0.029）和左心室整体纵向应变（beta 0.470，P=0.012）显著相关，但在男性中，没有相关性。与男性相比，高血压女性的左心室和动脉系统僵硬程度均更大，且对握力运动的 LV 收缩储备功能受损。心室-动脉不匹配仅在女性中对 LV 舒张和收缩功能障碍有显著影响，而在男性中则没有。
