title: Sex Differences in the Associations of Hemodynamic Load With Left Ventricular Hypertrophy and Concentric Remodeling.
abstract: BACKGROUND
  Left ventricular hypertrophy (LVH) and concentric remodeling are associated with adverse cardiovascular outcomes. We hypothesized that measures of arterial load are associated with LVH and concentric remodeling, and that associations differ by sex.
  
  
  METHODS
  We studied 600 non-Hispanic whites (59% women) belonging to hypertensive sibships. By integrating arterial tonometry with echocardiography, we obtained the following hemodynamic measures: aortic characteristic impedance (Z c), proximal aortic compliance (PAC), systemic vascular resistance, augmentation index, and carotid-femoral pulse wave velocity (cfPWV). LVH and concentric remodeling were assessed by left ventricular mass indexed to body surface area (LVMI) and relative wall thickness (RWT), respectively. LVMI was log-transformed to reduce skewness. Hemodynamic measures were indexed to body size. Sex-specific multivariable linear regression analyses adjusting for confounders were performed to assess the associations of measures of arterial load with log LVMI and RWT.
  
  
  RESULTS
  None of the hemodynamic measures were associated with LVMI in either sex, or with RWT in men. However, in women, measures of aortic stiffness and early, pulsatile hemodynamic load were independently associated with increased RWT: β ± SE = 0.008 ± 0.004 for Z c; 0.003 ± 0.001 for cfPWV, and -0.009 ± 0.003 for PAC (P ≤ 0.05 for each). Female sex was a significant effect modifier of the associations of Z c, cfPWV, and PAC with RWT (P ≤ 0.03 for each of the interaction terms).
  
  
  CONCLUSIONS
  Greater Z c and cfPWV and lower PAC are independently associated with increased RWT in women but not in men. Our findings suggest that aortic stiffness and greater early, pulsatile hemodynamic load affect left ventricular concentric remodeling in a sex-specific manner.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; tcoutinho@ottawaheart.ca.
authors.forename: Thais
authors.initials: T
authors.lastname: Coutinho
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA;
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA;
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.affiliation: Department of Medicine, Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Turner
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA;
authors.forename: Iftikhar J
authors.initials: IJ
authors.lastname: Kullo
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D017678:Sex Distribution; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014655:Vascular Resistance; D059289:Vascular Stiffness / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: arterial stiffness; blood pressure; hypertension; left ventricular hypertrophy; left ventricular mass index; left ventricular remodeling; relative wall thickness; sex differences.