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Sex Differences in Cardiometabolic Traits and Determinants of Exercise Capacity in Heart Failure With Preserved Ejection Fraction.


ABSTRACT:

Importance

Sex differences in heart failure with preserved ejection fraction (HFpEF) have been established, but insights into the mechanistic drivers of these differences are limited.

Objective

To examine sex differences in cardiometabolic profiles and exercise hemodynamic profiles among individuals with HFpEF.

Design, setting, and participants

This cross-sectional study was conducted at a single-center tertiary care referral hospital from December 2006 to June 2017 and included 295 participants who met hemodynamic criteria for HFpEF based on invasive cardiopulmonary exercise testing results. We examined sex differences in distinct components of oxygen transport and utilization during exercise using linear and logistic regression models. The data were analyzed from June 2018 to May 2019.

Main outcomes and measures

Resting and exercise gas exchange and hemodynamic parameters obtained during cardiopulmonary exercise testing.

Results

Of 295 participants, 121 (41.0%) were men (mean [SD] age, 64 [12] years) and 174 (59.0%) were women (mean [SD] age, 61 [13] years). Compared with men, women with HFpEF in this tertiary referral cohort had fewer comorbidities, including diabetes, insulin resistance, and hypertension, and a more favorable adipokine profile. Exercise capacity was similar in men and women (percent predicted peak oxygen [O2] consumption: 66% in women vs 68% in men; P?=?.38), but women had distinct deficits in components of the O2 pathway, including worse biventricular systolic reserve (multivariable-adjusted analyses: ?LVEF ??=?-1.70; SE, 0.86; P?Conclusions and relevanceDespite a lower burden of cardiometabolic disease and a similar percent predicted exercise capacity, women with HFpEF demonstrated greater cardiac and extracardiac deficits, including systolic reserve, diastolic reserve, and peripheral O2 extraction. These sex differences in cardiac and skeletal muscle responses to exercise may illuminate the pathophysiology underlying the development of HFpEF and should be investigated further.

SUBMITTER: Lau ES 

PROVIDER: S-EPMC6822160 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Sex Differences in Cardiometabolic Traits and Determinants of Exercise Capacity in Heart Failure With Preserved Ejection Fraction.

Lau Emily S ES   Cunningham Thomas T   Hardin Kathryn M KM   Liu Elizabeth E   Malhotra Rajeev R   Nayor Matthew M   Lewis Gregory D GD   Ho Jennifer E JE  

JAMA cardiology 20200101 1


<h4>Importance</h4>Sex differences in heart failure with preserved ejection fraction (HFpEF) have been established, but insights into the mechanistic drivers of these differences are limited.<h4>Objective</h4>To examine sex differences in cardiometabolic profiles and exercise hemodynamic profiles among individuals with HFpEF.<h4>Design, setting, and participants</h4>This cross-sectional study was conducted at a single-center tertiary care referral hospital from December 2006 to June 2017 and inc  ...[more]

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