Gender-Related Difference in Arterial Elastance During Exercise in Patients With Hypertension

Abstract

Abstract-Exercise intolerance and heart failure with preserved ejection fraction are common in females. Recently, arterial stiffness has been suggested to be a significant contributor in the development of heart failure. How gender difference affects arterial stiffening and its response to exercise is not well known. We hypothesized that arterial elastance index during exercise would be more abnormal in females with hypertension than males. Arterial elastance index was estimated as arterial end systolic pressure/stroke volume controlled for body surface area and was measured at rest and during graded supine bicycle exercise (25 watts, 3-minute increments) in 298 patients with hypertension (149 males; 149 females; mean age, 59). The subjects were divided into 2 groups by gender. Exercise duration was significantly shorter in females compared to males (692Ϯ222 versus 483Ϯ128 seconds, PϽ0.001). Although arterial elastance index at baseline was significantly higher in males, the magnitude of increase was steeper in females with the magnitude of change at 75 W of exercise being significantly higher in females compared to males (0.69Ϯ0.83 versus 0.43Ϯ0.69, Pϭ0.018). Arterial elastance index at each stage of exercise up to 75 W was independently associated with decreased exercise duration. In conclusion, despite lower arterial elastance index at rest, the increase during exercise was steeper in women with hypertension, suggesting a gender-related difference in dynamic arterial stiffness. The arterial elastance index during exercise was significantly associated with exercise duration in patients with hypertension. Key Words: gender Ⅲ arterial elastance index Ⅲ exercise Ⅲ hypertension Ⅲ heart failure I n epidemiology studies, nearly 50% of patients with heart failure have preserved ejection fraction and hypertension is considered to be the most important cause of heart failure with preserved ejection fraction. Interestingly, advanced age and the female gender are known to be associated with development of heart failure with preserved ejection fraction because the prevalence of heart failure with ejection fraction increases sharply with age than systolic heart failure, especially in females. 1,2 Recently, arterial stiffness has been suggested to be a significant contributor in the development of heart failure. 3,4 Increased aortic stiffness in subjects contributed to increased afterload to the heart while reducing coronary perfusion pressure during diastole. 3,4 Greater aortic stiffness may increase myocardial stiffness and left ventricular (LV) diastolic filling pressure, which may be exaggerated during exercise. 5 How gender difference affects arterial stiffening and its response to exercise is not well known; therefore, we hypothesized that arterial elastance index (EaI) during exercise would be more abnormal in female patients with hypertension compared to males. Methods Study PopulationSymptom-limited supine bicycle exercise (25 Watts, 3-minute increments) with simultaneous 2-dimensional and Doppler echocardiography ...

Use of the Frank-Starling mechanism during exercise is linked to exercise-induced changes in arterial load

“…Indeed when we separated our cohort into BP groups we find that ⌬E A I is associated with age and sex (data not shown). Further, Park et al (38) examined the change in E A I in the supine position and only reported data up to 75watts of exercise, which may further explain the differences between studies, as our figures show. E A I was originally derived from a 3-element Windkessel model which characterizes the hemodynamics of the arterial system as TACI, PVRI along with characteristic impedance (51).…”

“…In this study ⌬E A I was not associated with age or sex, which differs from previous studies. Park et al (38) found that older hypertensive women (59 Ϯ 8 yrs) expressed a greater change in E A I from rest to 75W compared with older (58 Ϯ 9 yrs) hypertensive men. Further, Najjar et al (34) found that during exercise E A I was similar in young and older normotensive men, but was higher in older vs. younger normotensive women.…”

Sex determines cardiovascular hemodynamics in hypertension

“…[1][2][3][4] It can be explained by the change of female hormonal status and the loss of cardiovascular protection provided by estrogens in premenopausal women. [4][5][6] In addition, hypertensive females, even in the absence of large coronary artery disease and left ventricular systolic dysfunction, tend to experience more symptoms related to AH, including impaired exercise tolerance and chest pain. 6 Although women with AH are more aware of the need of treatment and visit physicians more frequently 2 they do not reach satisfactory control of BP.…”

Value of Ventricular Stiffness Index and Ventriculoarterial Interaction in Patients With Nonischemic Dilated Cardiomyopathy

“…These parameters can be measured noninvasively. 9,[18][19][20] In this study, we found these indices of afterload were closely related to the ventricular diastolic functional indices at various exercise stages. Interestingly, despite no significant differences in the systemic vascular resistance index between the 3 groups, total arterial compliance and the pulsatile component of afterload significantly differed, thereby leading to differences in Ea.…”

“…Several studies also used noninvasively measured Ea during exercise. 18,22,23 Furthermore, we think that the main result of our study, which is that the resting VVI can predict exercise capacity, might not be significantly affected by this limitation. Future study should validate Doppler-derived Ees during exercise.…”