Sex-related pathophysiological mechanisms may be present before symptoms of HFpEF develop

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS ESC Heart Failure Pub Date : 2025-02-28 DOI:10.1002/ehf2.15228

B. Wong, J.D. Dodd, J. Gallagher, B. Dyer, C. Ryan, K. McDonald, M. Ledwidge

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Abstract

Aims

Understanding sex-related cardiovascular differences in those with pre-HFpEF (asymptomatic with normal ejection fraction, elevated natriuretic peptides and structural or functional heart disease) could help explain why females are more likely to develop symptomatic HFpEF compared with males. This study analyses sex-related cardiovascular differences in pre-HFpEF, including measures of cardiovascular stiffness and vascular resistance derived from cardiac magnetic resonance imaging (CMR) and Doppler echocardiography.

Methods and results

This post hoc analysis of the PARABLE trial enrolled 250 patients with pre-HFpEF. CMR and Doppler echocardiography were used to estimate baseline markers of cardiovascular stiffness and resistance, including effective arterial elastance (EAE), systemic vascular resistance (SVR), total arterial compliance (TAC), left ventricular end diastolic pressure (LVEDP) and left ventricular end diastolic chamber stiffness index (LVSId). The population median age was 72.0 [IQR 68.0; 77.0] years and 38.4% were female. Both sexes had a similar age, blood pressure, HbA1c, renal function and H2FPEF score. Fewer female participants had a diagnosis of diabetes and coronary artery disease. When adjusted for age, hypertension, diabetes, obesity and vascular disease, female participants had higher pulse pressures (62.1 (SD 15.3) vs. 60.1 (SD 12.5) mmHg, P < 0.001) as well as higher median [IQR] levels of LDL-cholesterol (2.50 [2.10; 3.25] vs. 2.00 [1.60; 2.40] mmol/L, P < 0.001), EAE (1.55 [1.26; 1.84] vs. 1.26 [1.05; 1.51] mmHg/mL/m², P < 0.001), SVR (1609 [1288; 1887] vs. 1336 [1132; 1734] mmHg/mL/min², P = 0.001), LVEDP (18.5 [17.2; 20.1] vs. 18.0 [16.9; 19.3] mmHg, P < 0.001) and LVSId (0.28 [0.24; 0.31] vs 0.24 [0.20; 0.29] mmHg/mL/m², P < 0.001) than males. Females had higher median [IQR] NT-proBNP (176 [95.8; 286] vs. 127 [81.5; 242] pg/mL, P < 0.001) and lower median [IQR] TAC (1.24 [0.99; 1.58] vs. 1.55 [1.18; 1.91] mL/mmHg, P < 0.001) than male participants.

Conclusions

Markers of elevated cardiovascular stiffness and vascular resistance are seen in female versus male participants with pre-HFpEF, suggesting that sex-related pathophysiological mechanisms are present before symptoms of HF develop.

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在HFpEF症状出现之前，可能存在与性相关的病理生理机制。

目的：了解HFpEF前期患者（无射血分数正常、利钠肽升高、结构性或功能性心脏病）的性别相关心血管差异，有助于解释为什么女性比男性更容易出现症状性HFpEF。本研究分析了hfpef前与性别相关的心血管差异，包括心脏磁共振成像（CMR）和多普勒超声心动图得出的心血管僵硬度和血管阻力指标。方法和结果：这项对PARABLE试验的事后分析纳入了250例hfpef前期患者。采用CMR和多普勒超声心动图估计心血管僵硬和阻力的基线指标，包括有效动脉弹性（EAE）、全身血管阻力（SVR）、总动脉顺应性（TAC）、左室舒张末期压（LVEDP）和左室舒张末期腔刚度指数（LVSId）。人口中位年龄为72.0岁[IQR 68.0；77.0岁，女性占38.4%。男女年龄、血压、HbA1c、肾功能和H2FPEF评分相似。更少的女性参与者被诊断患有糖尿病和冠状动脉疾病。经年龄、高血压、糖尿病、肥胖和血管疾病校正后，女性参与者的脉压更高(62.1 (SD 15.3) vs. 60.1 (SD 12.5) mmHg, p2, p2, P = 0.001), LVEDP (18.5 [17.2；20.1] vs. 18.0 [16.9；结论：hfpef前期患者中，女性和男性均存在心血管僵硬度和血管阻力升高的标志物，提示在HF症状出现之前，存在与性别相关的病理生理机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.