Sex Differences in Central Hemodynamics and Their Relationship to Left Ventricular Diastolic Function

• Published in: Journal of the American College of Cardiology Vol. 57; no. 10; pp. 1226 - 1233
• Main Authors: Shim, Chi Young, Park, Sungha, Choi, Donghoon, Yang, Woo-In, Cho, In-Jeong, Choi, Eui-Young, Chung, Namsik, Ha, Jong-Won
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 08.03.2011; Elsevier; Elsevier Limited
• Subjects: Aged; arterial stiffness; Arteries - pathology; Biological and medical sciences; Blood pressure; Blood Pressure - physiology; Cardiology; Cardiology. Vascular system; Cardiovascular; diastolic function; Drug therapy; Echocardiography, Doppler; Elasticity; Elasticity Imaging Techniques; Female; Heart attacks; Heart Failure - physiopathology; Hemodynamics; Humans; Internal Medicine; left ventricle; Male; Manometry; Medical sciences; Middle Aged; Radial Artery - physiopathology; sex; Sex Factors; Stroke Volume - physiology; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - physiopathology; arterial stiffness; PP; diastolic function; left ventricle; E; sex; Em; LV; BP; blood pressure; pulse pressure; early diastolic mitral annular; early diastolic mitral inflow; left ventricular; Circulatory system; Hemodynamics; Cardiology; Left ventricle performance; Comparative study; Sex
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2010.09.067

This study aimed to investigate sex differences in the association between arterial stiffness and left ventricular (LV) diastolic dysfunction. Heart failure with preserved ejection fraction is more common in women. Arterial stiffness has been suggested as a significant contributor to the development of heart failure. We hypothesized that the association between arterial stiffness and LV diastolic function would be stronger in women than in men. Two-dimensional, Doppler echocardiography and radial artery tonometry were performed simultaneously in 158 age-matched subjects (79 males, 79 females; mean age: 58 ± 10 years) without any structural heart disease or LV systolic dysfunction. The peripheral blood pressure and pulse pressure (PP) were similar between sexes. However, central PP and augmentation index were significantly higher and PP amplification was significantly lower in women (1.31 vs. 1.19, p < 0.001). The associations of PP amplification with early diastolic mitral annular (Em) velocity and transmitral to mitral annular early diastolic velocity ratio (E/Em) were significant in women (r = 0.38, p = 0.001; r = −0.36, p = 0.001), whereas no significant association was found in men (r = 0.09, p = 0.428, r = −0.14, p = 0.215). Multiple regression analysis revealed that PP amplification had an independent correlation with Em velocity only in women. Despite similar peripheral PP, the central hemodynamics reflecting arterial stiffness were different between men and women. LV diastolic function correlates significantly with the parameters representing arterial stiffness only in women. We suggest that the effects of earlier wave reflection on central pressure may contribute to greater susceptibility to heart failure with preserved LV ejection fraction in women.