To access this material please log in or register

Register Authorize

Left ventricular diastolic dysfunction in patients with IHD: Gender peculiarities

Sumin A. N.1, Korok E. V.1, Arkhipov O. G.2
1 – Federal State Budgetary Institution, “Research Institute for Complex Issues of Cardiovascular Diseases” at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002
2 – Federal Budgetary Institution, Rehabilitation Center “Topaz” of the RF Social Insurance Fund, Leskhoznaya 1, Myski 652840, Kemerovo Region

Keywords: gender peculiarities, diastolic dysfunction of the left ventricle, ischaemic heart disease

DOI: 10.18087/rhfj.2016.3.2229

Background. In recent years, effects of gender peculiarities on detection rate, clinical manifestations, and prediction of CHF have been extensively studied. Aim. To study gender peculiarities in indexes of LV diastolic function in patients with IHD. Materials and methods. The study included 718 patients with IHD who were evaluated at the Federal Budgetary Institution, Rehabilitation Center “Topaz” of the RF Social Insurance Fund. Based on gender and presence of LV diastolic dysfunction (DD), 4 groups of patients were formed: group 1 – women without LV DD (n=157; age 62 [56; 67]); group 2 – women with LV DD (n=130; age 63 [57; 70]); group 3 – men without LV DD (n=226; age 60 [54; 66]); and group 4 – men with LV DD (n=205; age 61 [56; 68]). EchoCG study was performed for all patients. Results. According to calculations, LV DD was observed in 47.7 % of male patients and 45.3 % of female patients (р=0.529). Although no significant intergroup differences were found for any LV DD pattern, the impaired relaxation pattern was observed more frequently than other patterns (29.4 and 30.3 %, respectively; р=0.793). Thus, isovolumic relaxation time (IVRT) was significantly increased in the presence of LV DD in both men and women (р<0.001). Mean LV early diastolic filling velocity (E) was higher in women without LV DD (71 cm/sec; р=0,007) whereas the LV late diastolic filling velocity (А) was the lowest in men without LV DD (66 cm/sec; р=0.002). Furthermore, the Е / А ratio was the lowest in women with LV DD (0.8; р=0.002) and the early diastolic mitral flow propagation velocity (EDMFPV) – in patients of both sexes with LV DD (р<0.001). According to results of logistic regression analysis the predictors influencing development of LV DD were age (р=0.008), smoking (р<0.001), presence of clinical signs of angina (р<0.001), AH (р=0.034), and reduced LV EF (р<0.001) in men and reduced LV EF (р=0.001) in women. Conclusion. Gender-related differences in features and prevalence of DD patterns were not observed. Among patients without signs of LV DD, male patients had lower than female patients LV early diastolic filling velocity and longer LV isovolumic relaxation time (p<0.05), which indicated impaired LV filling. Reduced LV EF was the factor associated with the presence of LV DD in both men and women (p<0.001 for both); in men, additional factors were age, smoking, AH, and angina.
  1. Агеев Ф. Т., Арутюнов Г. П., Беленков Ю. Н., Васюк Ю. А., Мареев В. Ю., Мартыненко А. В. и др. Хроническая сердечная недостаточность. – М.: «ГЭОТАР-Медиа», 2010. – С.7–18 [Ageev F. T., Arutyunov G. P., Belenkov Yu. N., Vasyuk Yu. A., Mareev V. Yu., Marty`nenko A. V. i dr. Xronicheskaya serdechnaya nedostatochnost`. – M.: «GE`OTAR-Media», 2010. – S.7–18].
  2. Бахшалиев Л. Б., Дадашова Г. М., Бахшалиева Г. И. Гендерные особенности факторов риска развития, возрастные и половые различия по тяжести и генезу хронической сердечной недостаточности. Терапевтический архив. 2015;87 (4):13–8 [Baxshaliev L. B., Dadashova G. M., Baxshalieva G. I. Genderny`e osobennosti faktorov riska razvitiya, vozrastny`e i polovy`e razlichiya po tyazhesti i genezu xronicheskoj serdechnoj nedostatochnosti. Terapevticheskij arxiv. 2015;87 (4):13–8].
  3. Martínez-Sellés M, Doughty RN, Poppe K, Whalley GA, Earle N, Tribouilloy C et al. Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis. Eur J Heart Fail. 2012 May;14 (5):473–9.
  4. Desai RV, Meyer P, Ahmed MI, Mujib M, Adamopoulos C, White M et al. Relationship between left and right ventricular ejection fractions in chronic advanced systolic heart failure: insights from the BEST trial. Eur J Heart Fail. 2011 Apr;13 (4):392–7.
  5. Martínez-Sellés M, Pérez-David E, Yotti R, Jiménez-Borreguero J, Loughlin G, Gallego L et al. Gender differences in right ventricular function in patients with non-ischaemic cardiomyopathy. Neth Heart J. 2015 Dec;23 (12):578–84.
  6. Doesch С, Dierks DM, Haghi D, Schimpf R, Kuschyk J, Suselbeck T et al. Right ventricular dysfunction, late gadolinium enhancement, and female gender predict poor outcome in patients with dilated cardiomyopathy. Int J Cardiol. 2014 Dec 15;177 (2):429–35 [Doesch S, Dierks DM, Haghi D, Schimpf R, Kuschyk J, Suselbeck T et al. Right ventricular dysfunction, late gadolinium enhancement, and female gender predict poor outcome in patients with dilated cardiomyopathy. Int J Cardiol. 2014 Dec 15;177 (2):429–35].
  7. Pedrotty DM, Jessup M. «Frailty, thy name is woman»: syndrome of women with heart failure with preserved ejection fraction. Circ Cardiovasc Qual Outcomes. 2015 Mar;8 (2 Suppl 1):S48–51.
  8. Ho JE, Lyass A, Lee DS, Vasan RS, Kannel WB, Larson MG, Levy D. Predictors of new-onset heart failure: differences in preserved versus reduced ejection fraction. Circ Heart Fail. 2013 Mar;6 (2):279–86.
  9. Wang F, Keimig T, He Q, Ding J, Zhang Z, Pourabdollah-Nejad S, Yang XP. Augmented healing process in female mice with acute myocardial infarction. Gend Med. 2007 Sep;4 (3):230–47.
  10. Ding L, Dong L, Chen Z, Zhang L, Xu X, Ferro A, Xu B. Increased expression of integrin-linked kinase attenuates left ventricular remodeling and improves cardiac function after myocardial infarction. Circulation. 2009 Sep 1;120 (9):764–73.
  11. Antonio EL, Serra AJ, dos Santos AA, Vieira SS, Silva JM, Yoshizaki A et al. Are there gender differences in left ventricular remodeling after myocardial infarction in rats? Rev Bras Cir Cardiovasc. 2015 Jan-Mar;30 (1):70–6.
  12. Li J, Ao L, Zhai Y, Cleveland JC, Fullerton DA, Meng X. Gender disparity in the role of TLR2 in post-ischemic myocardial inflammation and injury. Int J Clin Exp Med. 2015 Jul 15;8 (7):10537–47.
  13. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009 Mar;10 (2):165–93.
  14. Borlaug BA, Redfield MM. Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum. Circulation. 2011 May 10;123 (18):2006–13.
  15. Lee DS, Gona P, Vasan RS, Larson MG, Benjamin EJ, Wan TJ et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction; insights from the Framingham heart study of the national heart, lung, and blood institute. Circulation. 2009 Jun 23;119 (24):3070–7.
  16. Agha G, Loucks EB, Tinker LF, Waring ME, Michaud DS, Foraker RE et al. Healthy lifestyle and decreasing risk of heart failure in women: the Women’s Health Initiative observational study. J Am Coll Cardiol. 2014 Oct 28;64 (17):1777–85.
  17. Chen YZ, Qiao SB, Hu FH, Yuan JS, Yang WX, Cui JG et al. Left ventricular remodeling and fibrosis: sex differences and relationship with diastolic function in hypertrophic cardiomyopathy. Eur J Radiol. 2015 Aug;84 (8):1487–92.
  18. Chung AK, Das SR, Leonard D, Peshock RM, Kazi F, Abdullah SM et al. Women have higher left ventricular ejection fractions than men indepenedent of differences in left ventricular volume: the Dallas heart study. Circulation. 2006 Mar 28;113 (12):1597–604.
  19. Petrov G, Regitz-Zagrosek V, Lehmkuhl E, Krabatsch T, Dunkel A, Dandel M et al. Regression of myocardial hypertrophy after aortic valve replacement: faster in women? Circulation. 2010 Sep 14;122 (11 Suppl): S23–8.
  20. Rossi P, Francis Y, Kingwell BA, Ahimastos AA. Gender diffe­rences in artery wall biomechanical properties throughout life. J Hypertens. 2011 Jul;29 (6):1023–33.
  21. Foll D, Jung B, Schilli E, Staehle F, Geibel A, Hennig J et al. Magnetic resonance tissue phase mapping of myocardial motion: new insight in age and gender. Circ Cardiovasc Imaging. 2010 Jan;3 (1):54–64.
  22. Wohlfahrt P, Redfield MM, Lopez-Jimenez F, Melenovsky V, Kane GC, Rodeheffer RJ, Borlaug BA. Impact of general and central adiposity on ventricular-arterial aging in women and men. JACC Heart Fail. 2014 Oct;2 (5):489–99.
  23. Scantlebury DC, Borlaug BA. Why are women more likely than men to develop heart failure with preserved ejection fraction? Curr Opin Cardiol. 2011 Nov;26 (5):562–8.
  24. Тавлуева Е. В., Ярковская А. П., Барбараш О. Л. Взаимосвязь сахарного диабета с провоспалительным статусом у женщин и мужчин с ИМПST. Комплексные проблемы сердечно-сосудистых заболеваний. 2014;1:42–6 [Tavlueva E. V., Yarkovskaya A. P., Barbarash O. L. Vzaimosvyaz` saxarnogo diabeta s provospalitel`ny`m statusom u zhenshhin i muzhchin s IMPST. Kompleksny`e problemy` serdechno-sosudisty`x zabolevanij. 2014;1:42–6].
  25. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction. Am J Coll Cardiol. 2013 Jul 23;62 (4):263–71.
  26. Mohammed SF, Hussain S, Mirzoyev SA, Edwards WD, Maleszewski JJ, Redfield MM. Coronary microvascular rarefaction and myocardial fibrosis in heart failure with preserved ejection fraction. Circulation. 2015 Feb 10;131 (6):550–9.
  27. Сергеева С. С., Новожилова Н. В., Кузнецова Т. Ю. Факторы риска диастолической сердечной недостаточности у больных ишемической болезнью сердца. Журнал Сердечная Недоста­точность. 2014;15 (1):3–8 [Sergeeva S. S., Novozhilova N. V., Kuzneczova T. Yu. Faktory` riska diastolicheskoj serdechnoj nedostatochnosti u bol`ny`x ishemicheskoj bolezn`yu serdcza. Zhurnal Serdechnaya Nedostatochnost`. 2014;15 (1):3–8].
  28. Kishi S, Reis JP, Venkatesh BA, Gidding SS, Armstrong AC, Jacobs DR Jr et al. Race-ethnic and sex differences in left ventricular structure and function: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. J Am Heart Assoc. 2015 Mar 13;4 (3):e001264.
  29. Zhao Z, Wang H, Jessup JA, Lindsey SH, Chappell MC, Groban L. Role of estrogen in diastolic dysfunction. Am J Physiol Heart Circ Physiol. 2014 Mar 1;306 (5):H628–40.
  30. Milewska A, Krauze T, Piskorski J, Minczykowski A, Wykrętowicz A, Guzik P. Association between high arterial stiffness and left ventricular filling pressures in patients with acute myocardial infarction. Pol Arch Med Wewn. 2015;125 (11):814–22.
  31. Рогоза А. Н., Заирова А. Р., Жернакова Ю. В., Ощепкова Е. В., Чазова И. Е., Трубачева И. А. и др. Состояние сосудистой стенки в популяции взрослого населения на примере жителей Томска по данным исследования ЭССЕ-РФ. Системные гипертензии. 2014;11 (4):42–8 [Rogoza A. N., Zairova A. R., Zhernakova Yu. V., Oshhepkova E. V., Chazova I. E., Trubacheva I. A. i dr. Sostoyanie sosudistoj stenki v populyaczii vzroslogo naseleniya na primere zhitelej Tomska po danny`m issledovaniya E`SSE-RF. Sistemny`e gipertenzii. 2014;11 (4):42–8].
  32. Базаева Е. В., Мясников Р. П., Корецкий С. Н., Бойцов С. А. Возможности использования ультразвуковой методики оценки деформации миокарда при сердечной недостаточности с сохраненной фракцией выброса левого желудочка. Журнал Сердечная Недостаточность. 2015;16 (4):247–53 [Bazaeva E. V., Myasnikov R. P., Koreczkij S. N., Bojczov S. A. Vozmozhnosti ispol`zovaniya ul`trazvukovoj metodiki oczenki deformaczii miokarda pri serdechnoj nedostatochnosti s soxranennoj frakcziej vy`brosa levogo zheludochka. Zhurnal Serdechnaya Nedostatochnost`. 2015;16 (4):247–53].
  33. Павлюкова Е. Н., Кужель Д. А., Матюшин Г. В., Савченко Е. А., Филиппова С. А. Ротация, скручивание и раскручивание левого желудочка: физиологическая роль и значение в клинической практике. Рациональная фармакотерапия в кардиологии. 2015;11 (1):68–78 [Pavlyukova E. N., Kuzhel` D. A., Matyushin G. V., Savchenko E. A., Filippova S. A. Rotacziya, skruchivanie i raskruchivanie levogo zheludochka: fiziologicheskaya rol` i znachenie v klinicheskoj praktike. Raczional`naya farmakoterapiya v kardiologii. 2015;11 (1):68–78].
  34. Rigolli M, Rossi A, Quintana M, Klein AL, Yu CM, Ghio S et al. The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction: can age-stratified E / A ratio alone predict survival? Int J Cardiol. 2015 Feb 15;181:362–8.
  35. Сумин А. Н., Архипов О. Г. Показатели диастолической функции правого желудочка при различной выраженности легочной гипертензии у больных хроническим легочным сердцем. Журнал Сердечная Недостаточность. 2012;13 (1):13–8 [Sumin A. N., Arxipov O. G. Pokazateli diastolicheskoj funkczii pravogo zheludochka pri razlichnoj vy`razhennosti legochnoj gipertenzii u bol`ny`x xronicheskim legochny`m serdczem. Zhurnal Serdechnaya Nedostatochnost`. 2012;13 (1):13–8].
  36. Rodriguez Muñoz D, Markl M, Moya Mur JL, Barker A, Fernández-Golfín C, Lancellotti P, Zamorano Gomez JL. Intracardiac flow visualization: current status and future directions. Eur Heart J Cardiovasc Imaging. 2013 Nov;14 (11):1029–38.
  37. Hong GR, Kim M, Pedrizzetti G, Vannan MA. Current clinical application of intracardiac flow analysis using echocardiography. J Cardiovasc Ultrasound. 2013 Dec;21 (4):155–62.
  38. Abe H, Caracciolo G, Kheradvar A, Pedrizzetti G, Khandheria BK, Narula J, Sengupta PP. Contrast echocardiography for assessing left ventricular vortex strength in heart failure: a prospective cohort study. Eur Heart J Cardiovasc Imaging. 2013 Nov;14 (11):1049–60.
  39. Pasipoularides A, Vlachos PP, Little WC. Vortex formation time is not an index of ventricular function. J Cardiovasc Transl Res. 2015 Feb;8 (1):54–8.
  40. Pedrizzetti G, Domenichini F. Left ventricular fluid mechanics: the long way from theoretical models to clinical applications. Ann Biomed Eng. 2015 Jan;43 (1):26–40.
  41. Sun L, Ma C, Liu S, Zou L, Jia D. Mitral annular tissue velo­city in the diagnosis of coronary artery disease. Eur Rev Med Pharmacol Sci. 2014;18 (24):3754–60.
  42. Hsiao SH, Chiou KR, Lin KL, Lin SK, Huang WC, Kuo FY et al. Left atrial distensibility and E / e' for estimating left ventricular fil­ling pressure in patients with stable angina. A comparative echocardiography and catheterization study. Circ J. 2011;75 (8):1942–50.
Sumin A. N., Korok E. V., Arkhipov O. G. Left ventricular diastolic dysfunction in patients with IHD: Gender peculiarities. Russian Heart Failure Journal. 2016;17 (3):164–172

To access this material please log in or register

Register Authorize
Ru En