title: Right ventricular sex differences in patients with idiopathic pulmonary arterial hypertension characterised by magnetic resonance imaging: pair-matched case controlled study.
abstract: OBJECTIVE
  Sex differences exist in both the prevalence and survival of patients with idiopathic pulmonary arterial hypertension (IPAH). Men are less frequently affected by the condition but have worse outcome as compared to females. We sought to characterise the sex related differences in right ventricular remodelling in age matched male and female patients with IPAH using cardiac magnetic resonance imaging (MRI).
  
  
  METHODS
  A case controlled pair-matched study was conducted with patients matched by age and sex. Steady state free precession (SSFP) MRI of the heart was performed at 1.5T. Cardiac volume, function and mass measurements were corrected for age, sex and BSA according to reference data.
  
  
  RESULTS
  40 age and sex matched patients with IPAH were identified. The mean age was 57 (SD 17) in both male and female cohorts. Men had proportionally lower right ventricular (RV) ejection fraction, RV stroke volume and LV stroke volume than females, p=0.028, p=0.007 and p=0.013, respectively. However, there was no significant difference in RV mass or haemodynamic indices of mPAP and PVR between males and females.
  
  
  CONCLUSIONS
  Male patients with IPAH have proportionally worse RV function despite similar afterload. We hypothesise that adaptive remodelling of the RV in response to increased afterload in IPAH is more effective in females.
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom; INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Swift
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Dave
authors.initials: D
authors.lastname: Capener
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hammerton
authors.affiliation: Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Thomas
authors.affiliation: Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
authors.forename: Charlie
authors.initials: C
authors.lastname: Elliot
authors.affiliation: Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
authors.forename: Robin
authors.initials: R
authors.lastname: Condliffe
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom; INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Jim M
authors.initials: JM
authors.lastname: Wild
authors.affiliation: INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom; Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
authors.forename: David G
authors.initials: DG
authors.lastname: Kiely
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D065627:Familial Primary Pulmonary Hypertension / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012737:Sex Factors; D013318:Stroke Volume