Female sex-specific curtailment of left ventricular volume and mass in HFpEF patients with high end-diastolic filling pressure

Abstract

Background― Heart failure with preserved ejection fraction (HFpEF), a condition characterized by prominent central hemodynamic alterations, is highly prevalent in females. The mechanistic rationale underlying sex differences in the prevalence of HFpEF remains uncertain. The purpose of this study was to contrast left ventricular (LV) structure and function, along with LV filling pressures in male and female HFpEF patients. Methods― We conducted a retrospective assessment of HFpEF patients (n = 76, 38 % ♀) subjected to heart catheterization since January 2012. Clinical characteristics, LV structure, function and filling pressures were determined in male and female HFpEF patients. Results― Male and female HFpEF patients were remarkably similar regarding clinical characteristics such as age, body mass index, blood pressure, ejection fraction, NYHA score, etiology, comorbidities and use of medications. LV end-diastolic volume (LVEDV) (55.5 ± 11.4 vs. 48.0±12.4 ml∙m-2, P=0.022) and LV myocardial mass (LVMM) (218.3 ± 55.2 vs. 169.1 ± 37.4 g, P<0.001) were increased in male compared with female HFpEF patients; similar differences were observed for corresponding body surface area-indexed variables. No difference was detected regarding LV filling pressures (P≥0.509). Within the upper half of the LVEDP distribution, LVEDV and LVMM were markedly elevated (+57 % and 36 %, respectively) in male versus female HFpEF patients, whereas the LV concentricity index was only augmented in females. Conclusions― Male and female HFpEF patients with high LV filling pressures evidence a diametrically opposed LV remodeling consistent with the presence of sex dimorphism in the pathophysiology of the HFpEF condition.