Sex Differences in Central Hemodynamics and Their Relationship to Left Ventricular Diastolic Function

Shim, Chi Young; Park, Sungha; Choi, Donghoon; Yang, Woo In; Cho, In Jeong; Choi, Eui Young; Chung, Namsik; Ha, Jong Won

doi:10.1016/j.jacc.2010.09.067

Cited by 155 publications

(159 citation statements)

References 35 publications

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“…We have recently reported that degree of LA remodeling and LAA mechanical function in AF are closely related to LV diastolic dysfunction 12. Other studies have demonstrated that LV diastolic function is more likely to be found in women7 because of their tendency toward central aortic stiffness and increased susceptibility to load‐dependent LV diastolic dysfunction 9. Furthermore, the severity of LV diastolic dysfunction was found to be associated with increased risk of stroke as calculated by the CHADS 2 scoring system 28.…”

Section: Discussionmentioning

confidence: 94%

Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation: Potential Mechanism for Stroke

Lee

Kim

et al. 2016

JAHA

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BackgroundThe risk of stroke imposed by atrial fibrillation (AF) is significantly greater in women than men; however, the mechanism remains elusive. We hypothesized that left atrial (LA) remodeling and poor contractile function of LA appendage (LAA) would be more predominant in women than men among AF patients.Methods and ResultsA total of 579 AF patients (216 women vs age‐, AF type–, and incidences of heart failure, hypertension, diabetes mellitus, stroke or transient ischemic attack, and vascular disease–matched 363 men, 61.3±10.2 years old, 70.1% paroxysmal AF) who underwent AF catheter ablation were included. Sex differences in LA volume index (LAVI) and LAA emptying flow velocity (FV) were analyzed in risk factor 0, 1, and ≥2 groups, according to their CHA 2 DS 2‐VASc scores beyond sex category. LAA‐FV was more significantly reduced in women with risk factor ≥2 than in men of the same risk group (P=0.022). Women showed greater LAVI than their male counterparts in the risk factor ≥2 group (P<0.001). The majority of female patients with a history of stroke had a large LAVI and low LAA‐FV (P<0.001); however, no such distribution was observed in men (P=0.596). LA volume index (odds ratio [OR], 1.038; 95% CI, 1.003–1.075, P=0.035) or LAA‐FV (OR, 0.976; 95% CI, 0.952–0.999; P=0.047) was significantly associated with a history of stroke in women.ConclusionsMore‐extensive LA remodeling and deterioration in LAA function were noted in women than in men with high calculated risk of stroke in AF.

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Section: Discussionmentioning

confidence: 94%

Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation: Potential Mechanism for Stroke

Lee

Kim

et al. 2016

JAHA

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“…27 Left atrial volume index, again a marker of chronic LV diastolic dysfunction, and estimated LV diastolic filling pressure (E/Eʹ ratio) were significantly more strongly related to central as opposed to brachial PP in the entire population (left atrial volume index: r=0. 22 .…”

Section: Abnormal LV Diastolic Functionmentioning

confidence: 98%

Association of Central and Peripheral Blood Pressures With Intermediate Cardiovascular Phenotypes

Roman

Devereux

2014

Hypertension

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C entral blood pressure (BP) has been shown to predict cardiovascular disease clinical outcomes better than brachial BP in studies that demonstrate expected pulse pressure (PP) amplification. The likely underlying mechanism for this observation is a closer relation of central BP to preclinical cardiac and vascular disease because of its more accurate representation of loading conditions on the heart and coronary and cerebral vessels. Over the past 2 decades, proof of concept for this hypothesis has been provided by many cross-sectional analyses. Furthermore, several longitudinal studies in hypertensive patients have provided preliminary evidence to suggest that changes in central BP by pharmacological therapy are more important than decreases in brachial BP in altering cardiac and vascular hypertrophy associated with hypertension. This review will describe studies that have compared central and peripheral BP to intermediate cardiovascular phenotypes (target organ damage).Although end-diastolic BP is nearly identical throughout the arterial tree, it has been recognized for 50 years that systolic BP varies, at times strikingly, among arterial segments because of the phenomenon of arterial PP amplification.1-4 As a result, direct arterial pressure measurements with solid-state or fluid-filled catheters have shown that brachial and radial systolic BP is variably higher than concurrently measured central aortic systolic BP.5-9 Accordingly, the common practice of using conventional sphygmomanometric measurements of brachial BP as pressure load imposed on the heart and on central circulation (including coronary and cerebrovascular arterial trees) may be erroneous. The most commonly used measures of preclinical hypertensive target organ damage, 10 left ventricular (LV) mass and common carotid artery (CCA) geometry, can both be readily and accurately measured using noninvasive techniques, most commonly by the use of ultrasound. Noninvasive central BP has been most commonly derived using either carotid or radial artery applanation tonometry and invasively validated generalized transfer functions. 5,9 Carotid Artery Hypertrophy and AtherosclerosisNumerous studies have compared the relations of central pressure (predominately PP) versus brachial pressure with carotid wall thickness, lumen diameter, vascular mass, and presence and extent of atherosclerosis. These studies are described below and summarized in Table 1.In the first comparison of central and brachial PPs as determinants of carotid artery structure, Boutouyrie et al 11 measured right CCA internal diameter and intimal-medial thickness (IMT) in 43 healthy subjects and 124 never-treated hypertensives. Carotid PP was determined from carotid artery applanation, and brachial PP was measured using an oscillometric method. In univariate analyses, CCA diameter and IMT were more strongly related to carotid PP than brachial PP, and in multivariable models, carotid PP was an independent correlate of carotid artery structure, whereas mean brachial pressure and PP were not.In ...

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“…Previous population studies demonstrated that LV diastolic function is sensitive to increased central haemodynamics and arterial stiffness, particularly in women [24,40,41]. For instance, in our community-based sample, higher central pulse pressure (reflecting aortic compliance) independently predicted a stronger increase in LV mass and LV filling pressure (E/e' ratio) during five years of follow-up, but only in women (Fig.…”

Section: Diastolic Dysfunctionmentioning

confidence: 56%

Sex-specific differences in cardiac maladaptation to hypertension and arterial stiffening

Cauwenberghs

Kuznetsova

2018

Kardiol Pol

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A b s t r a c tThe overall prevalence of symptomatic heart failure (HF) is similar in men and women and constitutes about a quarter of the first manifestation of cardiovascular disease in both sexes. However, there is an important difference between the sexes in the type of HF. Whereas men more frequently develop HF with reduced ejection fraction, HF with preserved ejection fraction is especially frequent in women. The major risk factors for symptomatic HF are high blood pressure and arterial stiffness, which evoke a complex network of functional and structural changes in the heart in both men and women. In this review, we will discuss the recent epidemiological data on sex discrepancies in cardiac maladaptation to hypertension and arterial stiffening.

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Sex Differences in Central Hemodynamics and Their Relationship to Left Ventricular Diastolic Function

Cited by 155 publications

References 35 publications

Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation: Potential Mechanism for Stroke

Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation: Potential Mechanism for Stroke

Association of Central and Peripheral Blood Pressures With Intermediate Cardiovascular Phenotypes

Sex-specific differences in cardiac maladaptation to hypertension and arterial stiffening

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