Year: 2021
Type: conference-abstract
Abstract: Rationale Sex-based differences are important factors in the development and progression of pulmonary hypertension (PH).Women are consistently more likely to develop pulmonary arterial hypertension (PAH), but men with PAH have worse right ventricular (RV) function and an increased risk of death.However, it is not well established whether these differences are generalizable to all patients with PH.We sought to utilize the deep phenotyping of the Pulmonary Vascular Disease Phenomics (PVDOMICs) project to describe male:female ratio in all forms of PH and to test the hypothesis that males with PH are less able to compensate for mild increases in RV afterload associated with early PH.Methods Patients with PH identified at PVDOMICS study centers underwent deep phenotyping including right heart catheterization (RHC), cardiac magnetic resonance imaging (cMRI), and transthoracic echocardiogram (TTE).Subjects were grouped based on pulmonary vascular resistance (PVR): 0-2.3, 2.4-5 and >5 Wood units (WU), and differences in RV ejection fraction (EF) on cMRI between men and women were assessed using the Wilcoxin signed-rank test.Results 763 patients with PH (63% female) were enrolled.World Symposium on Pulmonary Hypertension (WSPH) Group 1 patients were most predominantly female at 72.8%.Groups 2 (56.6%), 3 (51.9%),and 4 (62.1%) also had a female predominance.Among the 355 PH patients (62.5% female) who had measurements of both RVEF on cMRI and end expiratory PVR from RHC, RVEF (38.4±10.3%vs 42.6±11.9%,p<0.001) was significantly lower in men than women.This relationship was consistent across all WSPH Groups and remained statistically significant in Groups 1-3.Similar differences in RV function were seen in RV strain (S') on TTE.Despite evidence of worse RV function, there was no significant difference in PVR between men and women (5.28±3.36vs 5.79±3.76WU, p=0.39).In PH patients with mild elevation in PVR (2.4-5 WU) (n=149, 59.1% female), RVEF was reduced in men (40.7±9.5% vs 46.6±10.3%,p<0.001); however, in patients with PVR >5 WU (n=156, 64.7% female), the trend toward worsened RVEF in men was not significant (34.5±9.9%vs 37.3±11.5%,p=0.11).Figure 1 shows a scatterplot of PVR and RVEF in men and women.Conclusions PH affects more women than men in WSPH Groups 1-4.Among patients with mild elevations in PVR, RV function is significantly worse in men than women.Differences in the ability to compensate to initial increases in RV afterload could help explain the sex-based differences in mortality observed in PH.
Institutions: Vanderbilt University Medical Center, Vanderbilt University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4251876202