Objectives
To assess sex-differences in ventricular-arterial interactions.
Background
Heart failure with preserved ejection fraction (HFpEF) is more prevalent in women than men, but the basis for this difference remains unclear.
Methods
Echocardiography and arterial tonometry were performed to quantify arterial and ventricular stiffening and interaction in 461 participants without heart failure (189 men, age 67±9 years; 272 women, age 65±10 years). Aortic characteristic impedance (Zc), total arterial compliance (TAC, pulsatile load) and systemic vascular resistance index (SVRI, steady load) were compared between men and women, and sex-specific multivariable regression analyses were performed to assess associations of these arterial parameters with diastolic dysfunction and ventricular-arterial coupling (effective arterial elastance/left ventricular end-systolic elastance, Ea/Ees) after adjustment for potential confounders.
Results
Zc was higher and TAC was lower in women, whereas SVRI was similar between sexes. In women but not men, higher Zc was associated with E/A ratio (β±SE: −0.17±0.07), diastolic dysfunction (OR 7.8; 95% CI: 2.0, 30.2) and Ea/Ees (β±SE: 0.13±0.0) (P≤0.01 for all). Similarly, TAC was associated with E/A ratio (β± SE: 0.12±0.04), diastolic dysfunction (OR 0.33; 95% CI: 0.12, 0.89) and Ea/Ees (β± SE: −0.09±0.03) in women only (P≤0.03 for all). SVRI was not associated with diastolic dysfunction or Ea/Ees.
Conclusions
Proximal aortic stiffness (Zc) is greater in women than men, and women may be more vulnerable to the deleterious effects of greater pulsatile and early arterial load on diastolic function and ventricular-arterial interaction. This may contribute to the greater risk of HFpEF in women.
Cardiac rehabilitation programs across Canada have suspended inperson services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared with centre-based programs. To minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation, however, can be daunting. Centres should initially focus on the collation, utilization, and R ESUM E Cardiac rehabilitation (CR) programs across Canada have suspended in-person, centre-based cardiac rehabilitation (CBCR) services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. CBCR has unequivocally demonstrated reductions in hospital readmissions, secondary events, and mortality in patients with cardiovascular disease. 1 Significant
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