Heart failure with preserved ejection fraction: Similarities and differences between women and men

Pepine, Carl J.; Merz, C. Noel Bairey; Hajj, Stephanie El; Ferdinand, Keith C.; Hamilton, Michèle A.; Lindley, Kathryn J.; Nelson, Michael D.; Quesada, Odayme; Wenger, Nanette K.; Fleg, Jerome L.

doi:10.1016/j.ijcard.2020.01.003

Cited by 26 publications

(17 citation statements)

References 90 publications

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“…Epidemiologically, hypertension is the most common risk factor for HFpEF. 32 Although peripheral and central BPs were not associated with LV diastolic function in this study, LV diastolic function assessed by lateral e´ and E/e´ was impaired in participants with hypertension. Hypertension was associated with increased E/e´ after adjustment for age, sex, BMI, and urine Na/K.…”

Section: Discussioncontrasting

confidence: 60%

“…Indices of diastolic function were comparable between men and women; however, previous epidemiological studies showed that diastolic dysfunction and HFpEF are more prevalent among elderly women. 32 As previously reported, women had higher peripheral PP, increased indices of wave reflections, such as Pa and Aix@75, and a higher prevalence of hypertension than men, despite their lower BMI, than men. These results suggest that an increased pulsatile afterload may contribute to LV concentric remodeling.…”

Section: Discussionsupporting

confidence: 55%

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Effects of a Low‐Salt and High‐Potassium Diet on Arterial Stiffness and Left Ventricular Function in Indigenous Papuans

Ishida

Isotani

Fujisawa

et al. 2021

JAHA

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Background A sodium‐restricted diet represents a potential non‐pharmacological strategy for improving blood pressure, arterial stiffness, and left ventricular (LV) diastolic function. We investigated age‐related differences in LV structure and function and the relationship between LV function and central hemodynamics in an indigenous Papuan population, who maintain a traditional lifestyle, including a low‐salt and high‐potassium diet. Methods and Results We measured LV dimensions, transmitral blood flow, and mitral annular tissue velocities through echocardiography and Doppler imaging. Blood pressure and brachial‐ankle pulse wave velocity were measured using an automatic device (Omron). Central blood pressure and wave reflection parameters were estimated via oscillometry (Mobil‐O‐Graph, using European calibrations). A total of 82 native Papuans (median age, 42 years; 38 women; no blood pressure treatment) were enrolled. Age‐related difference in brachial systolic pressure was modest but significant, and brachial‐ankle pulse wave velocity significantly increased with age; however, LV mass index remained unchanged. LV ejection fraction and global longitudinal strain were preserved; mitral A‐wave velocity and average E/e´ increased; and e´ and E/A decreased with age. Brachial‐ankle pulse wave velocity and spot urine Na/K were positively and independently correlated with E/e´. Age and heart rate were inversely associated with E/A. In conclusion, LV systolic function was preserved; however, LV diastolic function decreased with age in Papuans. Moreover, age‐related arterial stiffening, but not wave reflections, was inversely related to LV diastolic function. Conclusions Our results suggest that arterial and LV stiffness may not be altered by sodium restriction. Longitudinal studies are warranted to elucidate the effects of diet on arterial and LV function.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionsupporting

confidence: 55%

Effects of a Low‐Salt and High‐Potassium Diet on Arterial Stiffness and Left Ventricular Function in Indigenous Papuans

Ishida

Isotani

Fujisawa

et al. 2021

JAHA

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“…Studies have shown significant differences in cardiovascular remodeling between sexes, with women exhibiting left ventricular (LV) concentric remodeling, impaired diastolic function, and vascular stiffening, suggesting that a sex-specific phenotype exists in patients with HFpEF [6][7][8]. Mounting evidence suggests that estrogen deficiency is responsible for the development of HFpEF in women [9,10]. However, estrogen deficiency does not seem to be completely responsible for the differences in HFpEF prevalence between sexes.…”

Section: Introductionmentioning

confidence: 99%

Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction

Shi

Yang

Huang

et al. 2021

Cardiovasc Diabetol

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Background Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with sex-specific pathophysiology. Estrogen deficiency is believed to be responsible for the development of HFpEF in women. However, estrogen deficiency does not seem to be completely responsible for the differences in HFpEF prevalence between sexes. While diabetes mellitus (DM) frequently coexists with HFpEF in women and is associated with worse outcomes, the changes in myocardial contractility among women with HFpEF and the DM phenotype is yet unknown. Therefore, we aimed to investigate sex-related differences in left ventricular (LV) contractility dysfunction in HFpEF comorbid with DM. Methods A total of 224 patients who underwent cardiac cine MRI were included in this study. Sex-specific differences in LV structure and function in the context of DM were determined. LV systolic strains (global longitudinal strain [GLS], circumferential strain [GCS] and radial strain [GRS]) were measured using cine MRI. The determinants of impaired myocardial strain for women and men were assessed. Results The prevalence of DM did not differ between sexes (p > 0.05). Despite a similar LV ejection fraction, women with DM demonstrated a greater LV mass index than women without DM (p = 0.023). The prevalence of LV geometry patterns by sex did not differ in the non-DM subgroup, but there was a trend toward a more abnormal LV geometry in women with DM (p = 0.072). The magnitudes of systolic strains were similar between sexes in the non-DM group (p > 0.05). Nevertheless, in the DM subgroup, there was significant impairment in women in systolic strains compared with men (p < 0.05). In the multivariable analysis, DM was associated with impaired systolic strains in women (GLS [β = 0.26; p = 0.007], GCS [β = 0.31; p < 0.001], and GRS [β = −0.24; p = 0.016]), whereas obesity and coronary artery disease were associated with impaired systolic strains in men (p < 0.05). Conclusions Women with DM demonstrated greater LV contractile dysfunction, which indicates that women with HFpEF comorbid with DM have a high-risk phenotype of cardiac failure that may require more aggressive and personalized medical treatment.

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“…These findings were consistent with the data derived from the I-PRESERVE ( 8 ) and TOPCAT studies ( 17 ), and were also consistent with another meta-analysis ( 10 ) of the CHARM-Preserved (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity), I-PRESERVE, and TOPCAT—Americas studies: female HFpEF patients are older and more likely to have obesity and hypertension but less likely to have coronary artery disease or atrial fibrillation. Pepine et al reported in a recent study that the higher prevalence of obesity, hypertension, and other comorbidities in older women increases the prevalence of HFpEF in this group, which might explain that older women are more likely to develop HFpEF ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Characteristics and Outcomes in Elderly Heart Failure Patients With Preserved Ejection Fraction: A Post-hoc Analysis From TOPCAT

Sun

Tai

Guo

et al. 2021

Front. Cardiovasc. Med.

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Introduction: Although the impact of sex on patient outcomes for heart failure (HF) with preserved ejection fraction (HFpEF) has been reported, it is still unclear whether this impact is applicable for elderly patients with HFpEF. This study was conducted as a secondary analysis from a large randomized controlled trial—The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT)—to evaluate the impact of sex differences on the baseline characteristics and outcomes of HFpEF patients who were older than 70 years.Methods: Baseline characteristic of elderly patients were compared between men and women. Primary outcomes were cardiovascular (CV) mortality and HF-related hospitalization, whereas secondary outcomes were all-cause mortality and all-cause hospitalization. Cox regression models were used to determine the effect of sex differences on patient outcomes.Results: A total of 1,619 patients were included in the study: 898 (55.5%) women and 721 (44.5%) men. Age was similar between women and men. Women had fewer comorbidities but worse cardiac function than men. The rate of primary outcomes was lower in women than in men (18.4 vs. 27.5%; p < 0.001), including rate of CV mortality (8.9 vs. 14.8%; p < 0.001) and HF-related hospitalization (13.4 vs. 18.2%; p = 0.008). All-cause mortality was also lower in women than in men (15.6 vs. 25.4%; p < 0.001). After adjustment for baseline characteristics, Cox regression analysis showed that female sex was a protective factor for CV mortality [hazard ratio (HR): 0.53; 95% confidence interval (CI): 0.40–0.73], HF-related hospitalization (HR: 0.71; 95% CI: 0.55–0.93), and all-cause mortality (HR: 0.59; 95% CI: 0.47–0.75). Although spironolactone significantly reduced the rate of all-cause mortality in women even after adjusting for baseline characteristics (HR: 0.68; 95% CI: 0.48–0.96; p = 0.028), no significant multivariate association was noted between sex and treatment effects (p = 0.190).Conclusion: Among elderly patients with HFpEF, women had worse cardiac function but better survival and lower HF-related hospitalization rate than men.Clinical Trial Registration: NCT00094302 (TOPCAT). Registered October 15, 2004, https://www.clinicaltrials.gov/ct2/show/NCT00094302.

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Heart failure with preserved ejection fraction: Similarities and differences between women and men

Cited by 26 publications

References 90 publications

Effects of a Low‐Salt and High‐Potassium Diet on Arterial Stiffness and Left Ventricular Function in Indigenous Papuans

Effects of a Low‐Salt and High‐Potassium Diet on Arterial Stiffness and Left Ventricular Function in Indigenous Papuans

Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction

Sex Differences in Characteristics and Outcomes in Elderly Heart Failure Patients With Preserved Ejection Fraction: A Post-hoc Analysis From TOPCAT

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