Sex Hormones and the Right Ventricle: The MESA-Right Ventricle Study.

Ventetuolo, CE; Ouyang, Pamela; Bluemke, DA; Tandri, Harikrishna; Barr, R. Graham; Bagiella, Emilia; Bristow, Michael R.; Johnson, Craig W.; Kizer, Jorge R.; Lima, Joao; Kawut, S.M.

doi:10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a4150

Cited by 58 publications

(89 citation statements)

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“…Healthy women have lower RV mass, smaller RV volumes, and higher RVEF than men. 25 Ventetuolo et al 26 showed an association between higher estradiol levels and improved RVEF in women and an association between increased androgen levels be studied. Furthermore, the role of sex hormones, and the potential of substances targeting sex-specifi c pathways, such as estrogen receptor agonists, should be further evaluated.…”

Section: Discussionmentioning

confidence: 99%

The Right Ventricle Explains Sex Differences in Survival in Idiopathic Pulmonary Arterial Hypertension

Jacobs

Veerdonk²,

Trip³

et al. 2014

Chest

185

150

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Pulmonary arterial hypertension (PAH) is a rare disease characterized by obstructive lesions of the small pulmonary vessels, leading to increased pulmonary artery pressure (PAP), right-sided heart failure, and death within several years. 1,2 Despite the advent of improved therapies, outcome remains poor. 3,4 Prognosis correlates with severity of right ventricular (RV) structure and function. 2,5 More recently, male sex was identifi ed as an independent predictor of mortality. [6][7][8][9][10] Men treated with endothelin receptor antagonists had less 6-min walk distance (6MWD) improvement. 11 The cause of these sex differences is unknown; however, a distinct vascular and/or RV response to medical therapies is one possibility. Considering the need for improved treatments and "personalized therapy," Background: Male sex is an independent predictor of worse survival in pulmonary arterial hypertension (PAH). This fi nding might be explained by more severe pulmonary vascular disease, worse right ventricular (RV) function, or different response to therapy. The aim of this study was to investigate the underlying cause of sex differences in survival in patients treated for PAH. Methods: This was a retrospective cohort study of 101 patients with PAH (82 idiopathic, 15 heritable, four anorexigen associated) who were diagnosed at VU University Medical Centre between February 1999 and January 2011 and underwent right-sided heart catheterization and cardiac MRI to assess RV function. Change in pulmonary vascular resistance (PVR) was taken as a measure of treatment response in the pulmonary vasculature, whereas change in RV ejection fraction (RVEF) was used to assess RV response to therapy. Results: PVR and RVEF were comparable between men and women at baseline; however, male patients had a worse transplant-free survival compared with female patients ( P 5 .002). Although male and female patients showed a similar reduction in PVR after 1 year, RVEF improved in female patients, whereas it deteriorated in male patients. In a mediator analysis, after correcting for confounders, 39.0% of the difference in transplant-free survival between men and women was mediated through changes in RVEF after initiating PAH medical therapies. Conclusions: This study suggests that differences in RVEF response with initiation of medical therapy in idiopathic PAH explain a signifi cant portion of the worse survival seen in men.

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Section: Discussionmentioning

confidence: 99%

The Right Ventricle Explains Sex Differences in Survival in Idiopathic Pulmonary Arterial Hypertension

Jacobs

Veerdonk²,

Trip³

et al. 2014

Chest

185

150

View full text Add to dashboard Cite

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“…This is in contrast to studies in both group 1 PAH and group 2 PH that found the opposite: that men with PH fare worse than women, perhaps due to sex hormone-mediated differences in RV structure and adaptation. 10,13,14 Second, PH was more prevalent in nonHispanic blacks than other racial or ethnic groups. Blacks are known to have more severe and longer duration of hypertension than whites, which may lead to worse left-sided heart disease and an increased risk of PH.…”

mentioning

confidence: 99%

Pulmonary Hypertension in CKD

Sarnak

Roberts

2016

Journal of the American Society of Nephrology

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Pulmonary hypertension (PH), defined as a mean pulmonary artery pressure (mPAP) $25 mmHg, is described in numerous pathologic conditions and its presence is typically associated with worse outcomes. Experts in the field have established a clinical classification system which places patients with PH into five groups according to shared pathobiology, clinical presentation, and therapeutic approaches. 1 Although patients with CKD exhibit many symptoms and risk factors associated with PH, literature describing the epidemiology and impact of PH in CKD has been limited. Until recently, in fact, this literature was limited to CKD stages 4 and 5 with and without dialysis dependency. In these patients with advanced CKD, PH is prevalent (approximately 30%-40%) and associated with worse outcomes. 2,3 Reflective of poor insight into the nature of PH in this population, individuals with PH and ESRD are included in group 5 PH -that due to cryptic or multifactorial etiologies. The larger population with earlier stages of CKD bears a very high burden of cardiovascular morbidity and mortality; therefore, gaining additional knowledge related to PH in this population is of clinical relevance.The current study from Navaneethan et al. leverages the power of the Chronic Renal Insufficiency Cohort (CRIC), a large (n52959) longitudinal cohort study of subjects with eGFR 20-70 ml/min per 1.73 m 2 , providing the most comprehensive description to date of PH prevalence and significance in a nondialysis CKD population. 4 CRIC subjects underwent transthoracic Doppler echocardiography (TTE) interpreted centrally in a core laboratory, as well as detailed ascertainment of covariates and comorbid conditions, and thorough adjudication of cardiovascular and kidney outcomes. The authors used an accepted echocardiographic case definition of PH: pulmonary artery systolic pressure (ePASP) .35 mmHg and/or tricuspid regurgitant velocity .2.5 m/s.Concordant with recent studies from Italy and China, 5,6 PH was prevalent in the CRIC, present in roughly one in five subjects (21%), and was significantly and indirectly related to the eGFR, rising from 6% among CKD stage 1 to 33% in CKD stage 5. As has been described in other studies, PH was associated with older age, systemic hypertension, diabetes, and a history of heart failure (HF). 5,7 Multivariable analysis found that older age, lower hemoglobin, lower left ventricular ejection fraction, and the presence of left ventricular hypertrophy were independently associated with PH. The presence of PH was associated with a 38% increased risk of overall mortality and a 23% increased risk of cardiovascular events (HF, myocardial infarction, cerebrovascular accident, and peripheral vascular disease). In this cohort PH was not associated with progression of CKD.This study has value, not only for the relative novelty of the message that PH is prevalent in all stages of CKD, but additionally for its ability to assess predictors and mortality related to PH using a more systematized approach than prior studies. Despite ...

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“…При этом показано протективное влияние эстради-ола на сосуды малого круга и систолическую функцию ПЖ у женщин. Увеличение уровня андрогенов, напротив, было ассоциировано с увеличением объема и массы ПЖ у исследуемых обоих полов [24]. У женщин старших воз-растных групп наблюдалось снижение уровня эстрадиола, что отражалось на ухудшении функции ПЖ [24].…”

Section: гендерные особенности структуры и функции пжunclassified

“…Увеличение уровня андрогенов, напротив, было ассоциировано с увеличением объема и массы ПЖ у исследуемых обоих полов [24]. У женщин старших воз-растных групп наблюдалось снижение уровня эстрадиола, что отражалось на ухудшении функции ПЖ [24]. Возраст ассоциировался с уменьшением массы ПЖ при магнит-но-резонансной томографии (МРТ) примерно на 5 % за десятилетие, с бóльшим прогрессированием у муж-чин, чем у женщин (р<0,05), хотя в целом мужчины име-ли большую массу и объем ПЖ.…”

Section: гендерные особенности структуры и функции пжunclassified

Current issues in evaluation of the right ventricle condition: Role of gender and ethnic features and exercise

Arkhipov¹,

Сумин²

2017

RHFJ

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Sex Hormones and the Right Ventricle: The MESA-Right Ventricle Study.

Cited by 58 publications

References 0 publications

The Right Ventricle Explains Sex Differences in Survival in Idiopathic Pulmonary Arterial Hypertension

The Right Ventricle Explains Sex Differences in Survival in Idiopathic Pulmonary Arterial Hypertension

Pulmonary Hypertension in CKD

Current issues in evaluation of the right ventricle condition: Role of gender and ethnic features and exercise

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