Sex Matters: A Comprehensive Comparison of Female and Male Hearts

Abstract

Cardiovascular disease in women remains under-diagnosed and under-treated. Recent studies suggest that this is caused, at least in part, by the lack of sex-specific diagnostic criteria. While it is widely recognized that the female heart is smaller than the male heart, it has long been ignored that it also has a different microstructural architecture. This has severe implications on a multitude of cardiac parameters. Here, we systematically review and compare geometric, functional, and structural parameters of female and male hearts, both in the healthy population and in athletes. Our study finds that, compared to the male heart, the female heart has a larger ejection fraction and beats at a faster rate but generates a smaller cardiac output. It has a lower blood pressure but produces universally larger contractile strains. Critically, allometric scaling, e.g., by lean body mass, reduces but does not completely eliminate the sex differences between female and male hearts. Our results suggest that the sex differences in cardiac form and function are too complex to be ignored: the female heart is not just a small version of the male heart. When using similar diagnostic criteria for female and male hearts, cardiac disease in women is frequently overlooked by routine exams, and it is diagnosed later and with more severe symptoms than in men. Clearly, there is an urgent need to better understand the female heart and design sex-specific diagnostic criteria that will allow us to diagnose cardiac disease in women equally as early, robustly, and reliably as in men.Systematic Review Registrationhttps://livingmatter.stanford.edu/.

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“…The computational cardiac biomechanics model was adapted from the Living Heart Human Project (version 2.1, Simulia, Dassault Systèmes) ( Baillargeon et al, 2014 ), previously used for biomechanical simulation studies by ( Genet et al, 2014 ; Sack et al, 2016a , b ; Genet et al, 2016 ; Sack et al, 2018b , a ; Peirlinck et al, 2018 ; Dabiri et al, 2018 ; Sahli Costabal et al, 2019 ; Dabiri et al, 2019b , a ; Peirlinck et al, 2021 ; Guan et al, 2020 ; Sack et al, 2020 ; Dabiri et al, 2020 ; Wisneski et al, 2020 ; Heidari et al, 2022 ; St. Pierre et al, 2022 ). The dynamic problem was solved in Abaqus 2020 (Simulia, Dassault Systèmes) using meshes of the LV with 160,000 linear tetrahedral elements with an average edge length of 1.8 ± 0.5 mm.…”

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