title: Sex-specific cardiovascular structure and function in heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  Women are more likely to develop heart failure with preserved ejection fraction (HFpEF) than men. We studied the relationship between sex and cardiovascular structure and function in patients with HFpEF.
  
  
  RESULTS
  The study included 279 participants from the PARAMOUNT study (57% women) with analysable baseline echocardiograms (mean age 71 years, 94% hypertensive, 38% diabetic). We assessed sex-based differences in baseline clinical characteristics and measures of cardiovascular structure/function. Coronary artery disease was less common in women than in men. Women were more obese and symptomatic, and less likely to have albuminuria. Women had higher indexed left ventricular (LV) wall thicknesses, worse diastolic function (lower E', P = 0.002; higher E/E', P < 0.001), while LV mass and LV volumes indexed for height(2.7) were similar. Nonetheless, female sex was associated with a trend towards higher prevalence of abnormal LV geometry (defined as concentric hypertrophy, or eccentric hypertrophy, or concentric remodelling) at baseline (unadjusted P = 0.028, adjusted P = 0.056) and 12 weeks' follow up (unadjusted P = 0.001, adjusted P = 0.006), but not at 36 weeks' follow up (unadjusted P = 0.81, adjusted P = 0.99). Despite higher LV ejection fraction in women, global LV strain was similar between the sexes, while Tissue Doppler Imaging S' mitral velocity was lower in women. Both LV diastolic and systolic stiffness were higher in women than men (P < 0.001), even adjusting for LV concentricity and clinical covariates. We observed no sex differences in systolic arterial-LV coupling, as women also had higher absolute arterial elastance compared with men, although this difference was not significant after adjusting for height(2.7) .
  
  
  CONCLUSIONS
  More pronounced diastolic dysfunction may contribute to the greater predisposition for HFpEF in women compared with men.
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gori
authors.forename: Carolyn S P
authors.initials: CS
authors.lastname: Lam
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Gupta
authors.forename: Angela B S
authors.initials: AB
authors.lastname: Santos
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kraigher-Krainer
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Milton
authors.initials: M
authors.lastname: Packer
authors.forename: Toni
authors.initials: T
authors.lastname: Bransford
authors.forename: Martin
authors.initials: M
authors.lastname: Lefkowitz
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D009765:Obesity / Q000453:epidemiology*; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D059289:Vascular Stiffness; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology
keywords: Cardiovascular structure and function; Heart failure with preserved ejection fraction; Sex