Arterial Stiffness and Vascular Load in HFpEF: Differences Among Women and Men

Lau, EMILY S. and PANAH, LINDSAY G. and ZERN, EMILY K. and LIU, ELIZABETH E. and FARRELL, ROBYN and SCHOENIKE, MARK W. and NAMASIVAYAM, MAYOORAN and CHURCHILL, TIMOTHY W. and CURRERI, LISA and MALHOTRA, RAJEEV and NAYOR, MATTHEW and LEWIS, GREGORY D. and HO, JENNIFER E. (2022) Arterial Stiffness and Vascular Load in HFpEF: Differences Among Women and Men. Journal of Cardiac Failure, 28 (2). pp.202-211. ISSN 10719164

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BACKGROUND: Mechanisms underlying sex differences in heart failure with preserved ejection fraction (HFpEF) are poorly understood. We sought to examine sex differences in measures of arterial stiffness and the association of arterial stiffness measures with left ventricular hemodynamic responses to exercise in men and women. METHODS: We studied 83 men (mean age 62 years) and 107 women (mean age 59 years) with HFpEF who underwent cardiopulmonary exercise testing with invasive hemodynamic monitoring and arterial stiffness measurement (augmentation pressure [AP], augmentation index [AIx], and aortic pulse pressure [AoPP]). Sex differences were compared using multivariable linear regression. We examined the association of arterial stiffness with abnormal left ventricular diastolic response to exercise, defined as a rise in pulmonary capillary wedge pressure relative to cardiac output (PCWP/CO) >/= 2 mmHg/L/min by using logistic regression models. RESULTS: Women with HFpEF had increased arterial stiffness compared with men. AP was nearly 10 mmHg higher, and AIx was more than 10% higher in women compared with men (P < 0.0001 for both). Arterial stiffness measures were associated with a greater pulmonary capillary wedge pressure response to exercise, particularly among women. A 1-standard deviation higher AP was associated with > 3-fold increased odds of abnormal diastolic exercise response (AP: OR 3.16, 95% CI 1.34-7.42; P=0.008 [women] vs OR 2.07, 95% CI 0.95-5.49; P=0.15 [men]) with similar findings for AIx and AoPP. CONCLUSIONS: Arterial stiffness measures are significantly higher in women with HFpEF than in men and are associated with abnormally steep increases in pulmonary capillary wedge pressure with exercise, particularly in women. Arterial stiffness may preferentially contribute to abnormal diastolic function during exercise in women with HFpEF compared with men.

Item Type: Article
Subjects: R Medicine > R Medicine (General)
Depositing User: Repository Administrator
Date Deposited: 14 Apr 2022 03:54
Last Modified: 14 Apr 2022 03:54

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