Age‐ and Gender‐Dependent Left Ventricular Remodeling

Gebhard, Cathérine; Stähli, Barbara E.; Gebhard, Caroline E.; Tasnady, Hanna; Zihler, Deborah; Wischnewsky, Manfred; Jenni, Rolf; Tanner, Felix C.

doi:10.1111/echo.12264

Cited by 60 publications

(46 citation statements)

References 32 publications

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“…These differences in LV remodelling are consistent with the highest likelihood of women to present HFpEF. On the other hand, men are more likely to show age‐related increases in LV cavity dimension and LV systolic dysfunction, which are hallmarks of HFrEF . Consistent with these observations, male rats generally develop eccentric myocardial hypertrophy and fibrosis …”

Section: Sexual Dimorphism In Heart Failuresupporting

confidence: 52%

“…In addition to differences in HF aetiology, the phenotypic differences in HF presentation and prognosis between women and men may be the result of progressive, sex‐specific changes in cardiac and vascular physiology. This process of ‘CV ageing’ is the end result of years of interaction between traditional risk factors, such as hypertension, and an individual's intrinsic predisposition to develop CV diseases, such as inherited (genetic) factors …”

Section: Sexual Dimorphism In Heart Failurementioning

confidence: 99%

“…In women, HF aetiology is often hypertension, and women demonstrate greater body‐size adjusted increases in LV wall thickness and concentric remodelling than men, which predispose to myocardial stiffness and diastolic dysfunction. Furthermore, the age‐related increase in LVEF is more pronounced in women . In addition, animal models indicate that female rats are more likely to develop concentric myocardial hypertrophy .…”

Section: Sexual Dimorphism In Heart Failurementioning

confidence: 99%

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Sex, drugs, and heart failure: a sex‐sensitive review of the evidence base behind current heart failure clinical guidelines

et al. 2018

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Heart failure (HF) is a complex disease, almost as common in women as in men. Nonetheless, HF clinical presentation, prognosis, and aetiology vary by sex. This review summarizes the current state of sex‐sensitive issues related to HF drugs included in treatment guidelines and suggests future directions for improved care. Heart failure presentation differs between female and male patients: females more often show with hypertensive aetiology and the preserved ejection fraction phenotype, while men more often show ischaemic aetiology and the reduced ejection fraction phenotype. Yet the HF clinical guidelines in Europe, the United States, and Canada do not reflect the sexual dimorphism. Further, in randomized clinical trials of HF medication, women are largely underrepresented, typically consisting of ≥70% men. Given the knowledge that some adverse drug reactions, such as torsade de pointes and angiotensin‐converting enzyme inhibitor‐induced cough, occur more frequently in women, we emphasize the need to test medications thoroughly in both sexes and explore sexual dimorphisms. To better represent all of the targeted patient population and provide better care for all, two kinds of change must come about: recruitment methods to randomized clinical trial samples need to evolve and the participation needs to seem more attractive to women.

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Section: Sexual Dimorphism In Heart Failuresupporting

confidence: 52%

Section: Sexual Dimorphism In Heart Failurementioning

confidence: 99%

Section: Sexual Dimorphism In Heart Failurementioning

confidence: 99%

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Sex, drugs, and heart failure: a sex‐sensitive review of the evidence base behind current heart failure clinical guidelines

et al. 2018

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“…44,45 In addition, our results correlate well with previously published functional LV values for CMR and echocardiography. 46,47 Third, our results are based on a population that has been referred for cardiac CT. Patients with diabetes, hypertension, structural heart disease, and obstructive CAD were excluded, while patients with non-obstructive (,50% luminal narrowing) CAD were included in the analysis.…”

Section: Discussionmentioning

confidence: 99%

Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study

Gebhard

Buechel

Stähli

et al. 2016

European Heart Journal - Cardiovascular Imaging

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BackgroundLeft ventricular (LV) volumetric and functional parameters measured with cardiac computed tomography (cardiac CT) augment risk prediction and discrimination for future mortality. Gender-and age-specific standard values for LV dimensions and systolic function obtained by 64-slice cardiac CT are lacking. Methods and results1155 patients from the Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry (54.5% males, mean age 53.1 + 12.4 years, range: 18 -92 years) without known coronary artery disease (CAD), structural heart disease, diabetes, or hypertension who underwent cardiac CT for various indications were categorized according to age and sex. A cardiac CT data acquisition protocol was used that allowed volumetric measuring of LV function. Image interpretation was performed at each site. Patients with significant CAD (.50% stenosis) on cardiac CT were excluded from the analysis. Overall, mean left ventricular ejection fraction (LVEF) was higher in women when compared with men (66.6 + 7.7% vs. 64.6 + 8.1%, P , 0.001). This gender-difference in overall LVEF was caused by a significantly higher LVEF in women ≥70 years when compared with men ≥70 years (69.95 + 8.89% vs. 65.50 + 9.42%, P ¼ 0.004). Accordingly, a significant increase in LVEF was observed with age (P ¼ 0.005 for males and P , 0.001 for females), which was more pronounced in females (5.21%) than in males

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“…Furthermore, women experience more age-related concentric remodeling than men,8 which may be accompanied by more pronounced diastolic dysfunction 9. With respect to cardiac systolic function, LV ejection fraction (EF) increases with age in both sexes, and this increase is more pronounced in women 10. Women have also been shown to exhibit greater age-related systolic torsion and circumferential shortening of the LV 11.…”

Section: Cardiac Ageingmentioning

confidence: 99%

Sex differences in cardiovascular ageing

Merz

Cheng

2016

Heart

218

141

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Despite recent progress in identifying and narrowing the gaps in cardiovascular outcomes between men and women, general understanding of how and why cardiovascular disease presentations differ between the sexes remains limited. Sex-specific patterns of cardiac and vascular ageing play an important role and, in fact, begin very early in life. Differences between the sexes in patterns of age-related cardiac remodelling are associated with the relatively greater prevalence in women than in men of heart failure with preserved ejection fraction. Similarly, sex variation in how vascular structure and function change with ageing contributes to differences between men and women in how coronary artery disease manifests typically or atypically over the adult life course. Both hormonal and non-hormonal factors underlie sex differences in cardiovascular ageing and the development of age-related disease. The midlife withdrawal of endogenous oestrogen appears to augment the age-related increase in cardiovascular risk seen in postmenopausal compared with premenopausal women. However, when compared with intrinsic biological differences between men and women that are present throughout life, this menopausal transition may not be as substantial an actor in determining cardiovascular outcomes.

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Age‐ and Gender‐Dependent Left Ventricular Remodeling

Abstract: LVEF, LVFS, and LVMMI increase with advancing age, in particular in females. In contrast, LVEDVI decreases with age. These findings indicate that the LV undergoes a lifelong remodeling.

Cited by 60 publications

References 32 publications

Sex, drugs, and heart failure: a sex‐sensitive review of the evidence base behind current heart failure clinical guidelines

Sex, drugs, and heart failure: a sex‐sensitive review of the evidence base behind current heart failure clinical guidelines

Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study

Sex differences in cardiovascular ageing

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