Sex-related Differences In Heart Failure With Preserved Ejection Fraction In The Elderly

Objective:To investigate the sex difference of heart failure with preserved ejection fraction(HFpEF)in the elderly and to analyze the influencing factors.Methods:A total of 412 newly diagnosed HFpEF patients were divided into two groups according to sex,including 208 male HFpEF patients and 204 female HFpEF patients.The differences in clinical characteristics and cardiac structure function between the two groups were observed,and anal yze the influence of different risk factors on the right heart structure of different sexes.Results:The clinical symptoms of male patients with HFpEF,cough,lip cyanosis and lung rales were more common than female patients.The prevalenc e of chronic obstructive pulmonary disease(COPD),smoking and drinking wer e higher than those of females,and the prevalence of hypertension and obesity were higher in females than in males.The blood cell and biochemical indexes(red blood cell,hemoglobin,alanine aminotransferase,blood urea nitrogen,blo od creatinine,carotid-radial pulse wave velocity(CR-PWV))in male patients w ere higher than those in female patients,and the blood lipids in female patient s were higher.The indexes of left ventricle and left atrium(RV-FWd,RV-FWs,RV-D1,RV-D2,RV-D3,RVOT1,RVOT2,RA-D1,RA-D2,RAA)in male HFpEF pati ents were higher than those in female HFpEF patients.The indices of left atrial structure(LADi,LAVi),left ventricular diameter index,and related indices of l eft ventricular function(FS,E,A,LVEF,DT,E/E’_S,E/E’)in female HFpEF pati ents were all higher than those in male HFpEF patients.The indices of male ri ght heart structure(RV-FWd,RV-FWs,RV-D1,RV-D2,RV-D3,RVOT1,RVOT2,RA-D1,RA-D2,RAA)were higher than those of female.Multiple regression showed that RV-FWd and RV-FWs were independently correlated with diabetes mellit us,RV-D1,RA-D1 and RAA were independently correlated with coronary heart disease,RV-D3 was independently correlated with atrial fibrillation,RVOT1 w as independently correlated with COPD,and RA-D1 was independently correlat ed with hypertension in male patients.RV-D1,RA-D1 and RA-D2 were indepe ndently correlated with diabetes mellitus in woman,RV-D3 and RVOT2 were i ndependently correlated with obesity,and RV-FWd was independently correlate d with LAVi and pulmonary systolic blood pressure(PASP)in male patients i n terms of left heart structure and function.RV-FWs was independently correlat ed with relative wall thickness(RWT)and PASP,RV-D3 was independently c orrelated with E/A,RVOT2 was independently correlated with IVSTd and E/A,RA-D1 was independently correlated with LAVi and E/A,RA-D2 was indepe ndently correlated with IVSTd,LAVi and LADi,RAA was independently correl ated with IVSTd,LAVi and E/A,while female RV-FWs was independently corr elated with LVMi-AL and equal-volume relaxation time(IVRT),RV-D1 was in dependently correlated with IVRT,RV-D3 was independently correlated with L VMi-AL and IVRT,RVOT1 was independently correlated with E/E’,RVOT2was independently correlated with LAVi,RA-D1 was independently correlated with IVSTd,RA-D2 was independently correlated with LVMi-AL,RAA was in dependently correlated with RWT.Conclusion:There are significant differences in clinical basic c haracteristics,cardiac structure and function,common comorbidities and extracardiac factors in male and female HFpEF patients,which may make older women more vulnerable HFpEF,Among the risk fa ctors affecting HFpEF right heart structure,diabetes affects both me n and women,and obesit y affects women’s right heart structure,whi le hypertension,coronary heart disease,atrial fibrillation,COPD affe ct men’s right heart structure,The influence of left ventricular struc ture and function on r ight ventricular structure is different in males and females.