Background Altered ventricular-vascular coupling (VVC) is a key mechanism in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Arterial elastance (Ea), an integral component of VVC, has a static and pulsatile component which could be affected by the physical differences in men and women. We hypothesised differences in height may explain some of the sex-differences in pulsatile load, which has been linked to the development of HFpEF.
Methods We retrospectively analysed echocardiographic data from a large prospective community study of people aged >60 years. Height, arterial elastance (Ea), the pulsatile and static components of Ea (total arterial compliance (TAC) and systemic vascular resistance (SVR)), were calculated and compared between the sexes and across three groups: HFpEF, hypertensive (HTN) controls, and healthy controls.
Results There were 142 HFpEF patients (73±7 years, 74% female), 725 HTN controls (70±7 years, 49% female) and 205 healthy controls (67±5 years, 59% female) (Table 1).
There was a significant correlation between TAC and height in the participants as a group (r=0.218, p<0.001; Figure 1A). By sex-groups, a correlation between TAC and height was seen in HTN men only (r=0.149; p=0.004; Figure 1B), with no correlation seen in women (r=0.068, p=0.106; Figure 1C).
Height was only an independent predictor of TAC when controlling for sex in HTN controls (β=0.11, p=0.047). Women were shorter than men (p<0.001 for all groups) and had significantly higher Ea and lower TAC, except in the HFpEF group. Men with HFpEF were shorter than male healthy controls (p<0.05). In healthy men and men with hypertension, taller stature was associated with lower Ea and TAC (β=0.125, p=0.019).
Conclusions Women have significantly higher Ea and lower TAC. In both men and women with hypertension, a taller stature was independently associated with reduced pulsatile arterial load and Ea. Women are more susceptible to the deleterious effects of low TAC, which may partly explain the sex differences in the prevalence of HFpEF.
Conflict of Interest None
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