Benjamin Nicola, Schiffer Veronika, Resag Carolin, Xanthouli Panagiota, Braun Moritz, Harutyunova Satenik, Eichstaedt Christina A, Egenlauf Benjamin, Marra Alberto M, Bossone Eduardo, Cittadini Antonio, Kiely David G, Grünig Ekkehard
Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.
Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.
J Am Soc Echocardiogr. 2025 Mar;38(3):273-285. doi: 10.1016/j.echo.2024.11.015. Epub 2024 Dec 18.
In healthy subjects, sex differences in right heart function have been detected for various echocardiographic parameters. The objective of this study was to investigate sex differences in echocardiographic European Society of Cardiology (ESC)/European Respiratory Society (ERS) risk stratification parameters and their impact on survival estimation in patients with pulmonary arterial hypertension (PAH).
In this retrospective, cross-sectional study with a mean follow-up time of 3.2 ± 2.65 years (median, 2.78 years), clinical parameters including right atrial (RA) area, right ventricular area, and tricuspid annular plane systolic excursion (TAPSE) divided by systolic pulmonary artery pressure (sPAP) were assessed. Thresholds of ESC/ERS risk stratification were compared using multivariable Cox regression analysis.
Of 748 patients with PAH (mean age, 65 ± 15 years; 63% women), men had significantly larger right heart size than women (RA area 21.76 ± 7.64 vs 17.65 ± 6.82 cm, P < .001; right ventricular area 24.02 ± 7.15 cm vs 18.41 ± 5.75 cm, P < .001). This difference was consistent throughout all World Health Organization functional classes and cardiac index risk groups, except for the RA area in the cardiac index high-risk group and World Health Organization functional class IV. On multivariable analysis, indexed values showed more pronounced differences for age-adjusted survival analysis compared with ESC/ERS risk stratification thresholds. TAPSE/sPAP showed no significant sex differences, which makes this parameter a robust prognostic predictor.
This is the first study focusing on sex differences in right heart size obtained by echocardiography in patients with PAH. For risk stratification indexing RA area to body surface area could be more reflective of body composition. In contrast, TAPSE/sPAP values were not sex dependent and were a robust prognostic factor in patients with PAH.
在健康受试者中，已检测到多种超声心动图参数存在右心功能的性别差异。本研究的目的是调查超声心动图欧洲心脏病学会（ESC）/欧洲呼吸学会（ERS）风险分层参数中的性别差异及其对肺动脉高压（PAH）患者生存估计的影响。
在这项回顾性横断面研究中，平均随访时间为3.2±2.65年（中位数为2.78年），评估了包括右心房（RA）面积、右心室面积以及三尖瓣环平面收缩期位移（TAPSE）除以收缩期肺动脉压（sPAP）在内的临床参数。使用多变量Cox回归分析比较ESC/ERS风险分层的阈值。
在748例PAH患者中（平均年龄65±15岁；63%为女性），男性的右心大小显著大于女性（RA面积21.76±7.64 vs 17.65±6.82 cm，P<.001；右心室面积24.02±7.15 cm vs 18.41±5.75 cm，P<.001）。除了心脏指数高危组和世界卫生组织功能分级IV级中的RA面积外，这种差异在所有世界卫生组织功能分级和心脏指数风险组中均一致。在多变量分析中，与ESC/ERS风险分层阈值相比，指数值在年龄调整生存分析中显示出更明显的差异。TAPSE/sPAP未显示出显著的性别差异，这使得该参数成为一个可靠的预后预测指标。
这是第一项关注PAH患者经超声心动图测量的右心大小性别差异的研究。对于风险分层，将RA面积与体表面积进行指数化可能更能反映身体组成。相比之下，TAPSE/sPAP值不依赖于性别，是PAH患者的一个可靠预后因素。
