Chest
Pulmonary and Cardiovascular: Original ResearchSex-Related Differences in Dynamic Right Ventricular-Pulmonary Vascular Coupling in Heart Failure With Preserved Ejection Fraction
Section snippets
Study Population and Design
We identified patients from the Brigham and Women’s Hospital Dyspnea Clinic evaluated for unexplained exercise intolerance between March 2011 and January 2020 with resting supine right heart catheterization (RHC) followed by symptom-limited upright invasive cardiopulmonary exercise testing (CPET).26 The study protocol was approved by Partners Healthcare Human Research Committee (2011P000272). All patients signed informed consent and agreed to have their anonymized clinical and invasive CPET
Demographic and Clinical Characteristics
From a total of 1,908 invasive CPET studies, 338 patients were identified on the basis of the aforementioned resting supine and peak exercise hemodynamics.29 Based on the exclusion criteria, 49 patients were then selected for the current study (27 female patients and 22 male patients with HFpEF). Control subjects included 15 female subjects and 11 male subjects. The study sample thus consisted of 75 subjects (e-Fig 1).
There were no differences in age, BMI, medication use, comorbidities, or
Discussion
The current study found that despite similar resting RV afterload, male patients with HFpEF exhibited greater dynamic RV-PA uncoupling, with resulting reduced peak exercise aerobic capacity compared to their female counterparts. The RV-PA uncoupling observed in male patients with HFpEF is the culmination of disproportionate increases in RV afterload along with an impaired contractile reserve during exercise. In contrast, female patients with HFpEF were able to augment their RV contractile
Conclusions
In this study, we showed that male and female patients with HFpEF have a different dynamic RV-PA response during maximum incremental exercise. Female patients with HFpEF were able to augment RV contractility in the face of increasing RV afterload, thus preserving RV-PA coupling at peak exercise. In contrast, RV-PA coupling worsened dynamically in male patients with HFpEF because they experienced a greater increase in RV afterload without a concomitant increase in RV contractility. As a result,
Acknowledgments
Author contributions: I. S., R. K. F. O., P. M. H., D. M. S., and A. B. W. contributed to conception and design of the work, as well as interpretation of the data and writing. I. S. and R. P. contributed to data acquisition and analysis. All authors approved the final version of the manuscript and are accountable for all aspects of the work.
Financial/nonfinancial disclosures: None declared.
Additional information: The e-Appendix, e-Figure, and e-Tables can be found in the Supplemental Materials
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FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.