The effect of parity on exercise physiology in women with heart failure with preserved ejection fraction

Abstract

Aims Women are overrepresented amongst patients with heart failure with preserved ejection fraction (HFpEF); however, the underpinning mechanism for this asymmetric distribution is unclear. Pregnancy represents a potential gender‐specific risk factor for HFpEF. It leads to significant physiological adaption, and increasing parity has been associated with some cardiovascular risk. We sought to examine the relationship between prior parity with the rest and exercise haemodynamic and echocardiographic profile of women with HFpEF. Methods and results Patients referred for assessment of exertional dyspnoea and confirmed to have a haemodynamic and clinical profile consistent with HFpEF were included. Detailed evaluation consisted of rest and exercise right heart catheterization and echocardiography. A socio‐economic and obstetric history was also documented. Fifty‐eight women were assessed and categorized as having either 0–2 births or ≥3 births, dividing the cohort equally. Women with ≥3 births achieved a lower symptom‐limited workload than those with 0–2 births [38 (24–51) vs. 46 (31–68) W, P = 0.04]. Women with ≥3 births had a greater rise in pulmonary capillary wedge pressure indexed to workload with exercise [0.5 (0.3–0.8) vs. 0.3 (0.2–0.5) mmHg/W, P = 0.03], paralleled by a greater rise in right atrial pressure [10 (8–12) vs. 7 (3–11), P = 0.01]. Pulmonary vascular resistance was also higher in women with ≥3 births [1.9 (1.6–2.4) vs. 1.6 (1.4–1.9) mmHg/L/min rest, P = 0.046, and 1.9 (2.4–2.4) vs. 1.4 (1–1.8) mmHg/L/min exercise, P = 0.024]. Left ventricular ejection fraction was lower at rest [60 (57–61) vs. 63 (60–66), P = 0.008] and during exercise [65 (62–67) vs. 68 (66–70), P = 0.038] in women with higher parity. Conclusions Higher parity is associated with greater impairments in multiple physiologic parameters of HFpEF severity in women, including diastolic reserve, pulmonary vascular resistance, and systolic dysfunction.

Study on the influencing factors of postpartum quality of life in women with heart disease

“…Extant research indicates that increasing parity harms women's health and elevates the risk of cardiovascular disease [52,53]. In addition, repeated cardiovascular adaptation to volume overload can lead to adverse cardiac remodelling, an independent risk factor for left ventricular diastolic dysfunction in women with heart disease [54][55][56].…”

Mecanismos Fisiopatológicos, Avaliação Clínica E Estratégias De Manejo Da Regurgitação Tricúspide

“…O sexo feminino é um preditor independente da gravidade e progressão da regurgitação tricúspide 12,24 . Embora a base para essas diferenças seja desconhecida, a maior prevalência feminina de IC com fração de ejeção preservada e a fibrilação atrial pode desempenhar um papel [25][26][27] .…”

Diastolic dysfunction and sex-specific progression to HFpEF: current gaps in knowledge and future directions

“…Potentially, reversible changes in each pregnancy may gradually lead to irreversible diastolic impairment. Also, in a cohort of HFpEF patients, women with ≥ 3 deliveries achieved a lower symptom-limited workload, developed a greater rise in pulmonary capillary wedge pressure indexed to workload, and had higher pulmonary vascular resistance than those with 0–2 births [ 93 ]. The authors hypothesized that pregnancies contribute to systemic inflammation, with possible mechanisms including adverse lipid profiles, upregulation of the renin–angiotensin–aldosterone system, and increased insulin resistance during pregnancy.…”

“…Auto-immune disease Established risk factor for CHD [91]. Research on HFpEF risk urgently needed [92] Pregnancy number Associated with diastolic-and exercise-RHC abnormalities [18,93]. Research on HFpEF risk urgently needed…”