Age and gender differences in phenotype of heart failure with preserved left ventricular ejection fraction in patients with arterial hypertension

Abstract

The aim — to determine differences in the structure and function of the heart, arterial stiffness, resistive and pulsative loads and ventricular‑arterial connection in patients with arterial hypertension, confirmed heart failure (HF) and preserved ejection fraction, depending on age and gender.Materials and methods. The study included 115 patients (62 (53.9 %) men and 53 (46.1 %) women, average age — 67.3 ± 9.7 years) with a diagnosis of HF with preserved EF of IIA or IIB stage, II — III functional class according to NYHA, left ventricular (LV) ejection fraction (EF) ≥ 50 % and signs of LV diastolic dysfunction according to transthoracic echocardiography, who were divided into two groups by gender and two groups by age (≥ 65 years and < 65 years). All patients underwent general clinical examination, determination of the level of N‑terminal fragment of brain natriuretic peptide (NT‑proBNP), transthoracic echocardiography, applanation tonometry, test with 6‑minute walk. The frequency of comorbid conditions (non‑cardiac and cardiac) was analyzed.Results and discussion. When analyzing the frequency of cardiac comorbidity, we detected the same frequency of myocardial infarction (MI) and, in particular, Q‑MI in older and younger men, as well as in women (p < 0.05), with a lower incidence of MI in the anamnesis in women than in men in each age group (p < 0.05 — 0.01). The distance of the 6‑minute walk was smaller in the older age groups and in women than in men regardless of age (p < 0.05). A higher NT‑proBNP level was associated with older age and female gender (p < 0.05). Young women had a lower (p < 0.05) and older women had a higher (p < 0.05) incidence of obesity than men with the same frequency of diabetes in all 4 groups (p > 0.05). The glomerular filtration rate was lower in the elderly, and the frequency of anemia in these groups of patients was higher. In women of both age groups it was lower than in men (p < 0.05—0.01) with a correspondingly higher incidence of chronic kidney disease (p < 0.0—0.01). The expressiveness of LV hypertrophy in the mean value of the myocardial mass index of the LV was greater in old age, in women of both age groups it was less pronounced than in men (by 13.2 and 12.7 %, respectively, p < 0.05), and was associated with age deterioration of the diastolic function in women — a decrease in the mean e’ and DT (by 3.4 and 5.1 %, respectively, p < 0.05) and an increase in diastolic elastance (by 4.1 %, p < 0.05 compared with patients aged < 65 years). High values of diastolic elastance and left atrial volume index (by 4.2 and 10.0 %, p < 0.05) and a lower average level of DT (by 11.7 %, p < 0.05) in these patients confirmed a more pronounced diastolic dysfunction. The systolic pressure in the pulmonary artery was greater in women than in men, both at age < 65 years (by 20.5 %, p < 0.01) and ≥ 65 years (by 19.6 %, p < 0.01). The end‑diastolic LV volume index increased with age only in women (by 10.3 %, p < 0.05) and in both age groups it was smaller than in men (by 18.7 and 6.5 %, respectively, p < 0.05). This could be due to the greater severity of diastolic dysfunction in women, mostly young, as evidenced by their lower impact index (by 14.1 %, p < 0.05). A lesser frequency among women of cases of myocardial infarction could play a certain role. It was associated with greater EF in younger women compared with men (by 4.9 %, p < 0.05). In the absence of differences in brachial and central systolic blood pressure between all groups, the resistive load on the LV according to the mean brachial systolic blood pressure, systemic vascular resistance and Ea in women was higher than in men both at a young age (114.1 ± 9.1 and 94.7 ± 9.4; 1.8 ± 0.2 and 1.5 ± 0.4; 2.48 ± 0.91 and 1.97 ± 0.38, respectively, p < 0.05), and at an older age (106.2 ± 7.7 and 98.6 ± 10.9; 2.2 ± 0.5 and 1.6 ± 0.4; 2.14 ± 0.23 and 1.97 ± 0.39, respectively, p < 0.05), without significant age differences in mean brachial arterial pressure and Ea (p > 0.05) for both sexes. When assessing the pulse load, an increase in the augmentation index was detected, standardized to a heart rate of 75 per 1 min and a pulse wave velocity in older women, compared with older men (24.9 ± 4.3 and 22.4 ± 5.7; 13.04 ± 1.4 and 12.4 ± 1.9, respectively (p < 0.05).Conclusions. Among patients with hypertension and verified HF with preserved EF, in younger women compared with men there was a greater degree of diastolic dysfunction in terms of diastolic elastance, left atrial volume index, DT, an increase in systolic pressure in the pulmonary artery and NT‑proBNP level at the same frequency atrial fibrillation and body mass index. With a greater resistive load on the LV in terms of systemic vascular resistance and Ea, women patients with hypertension and heart failure with preserved EF had a higher pulse load (according to ascending augmentation index standardized to heart rate of 75 per 1 min and pulse wave velocity) than men with comparable central systolic blood pressure, regardless of age.