Gender-related differences in left atrial strain mechanics and exercise capacity in hypertrophic cardiomyopathy: a propensity-score matched study from the Cleveland Clinic.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular diagnosis and therapy Pub Date : 2024-08-31 Epub Date: 2024-07-26 DOI:10.21037/cdt-24-147

Bo Xu, Yoshihito Saijo, Nicholas G Smedira, Erik Van Iterson, Maran Thamilarasan, Zoran B Popović, Milind Y Desai

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引用次数: 0

Abstract

Background: Male and female patients with hypertrophic cardiomyopathy (HCM) differ in physiologic characteristics and hemodynamics. Little is known about gender-related differences in left atrial (LA) strain and exercise capacity. The aim of this study was to assess the gender-related differences in the relationship between exercise capacity and cardiac function including LA function in patients with HCM.

Methods: Five hundred and thirty-two patients with HCM undergoing exercise stress echocardiography and cardiopulmonary exercise testing (CPET) were prospectively recruited between October 2015 and April 2019 as part of a cohort study in a quaternary referral center. To reduce potential confounding factors, propensity score (PS) matching was performed in 420 patients. LA strain mechanics were evaluated using speckle-tracking echocardiography.

Results: The majority of patients were male, comprising 58% of the total. Female HCM patients were older (54±14 vs. 50±15 years, P=0.002). After PS matching, percent-predicted peak VO₂ was similar between the genders (67.5%±20.7% vs. 65.8%±21.8%, P=0.41), even though female HCM patients had lower peak VO₂ (17.7±5.9 vs. 24.1±8.3 mL/kg/min, P<0.001). Left ventricular (LV) diastolic function was worse for female HCM patients. This is shown by worse E/e' ratio (15.0±5.9 vs. 12.9±6.4, P<0.001) and larger LA volume in respect to LV (0.88±0.35 vs. 0.74±0.31, P<0.001), compared with male HCM patients. The gender-related differences in LA reservoir strain were more evident for patients aged 60 years and older (27.5%±8.8% vs. 30.9%±9.1%, P=0.03). LA reservoir strain was found to have a significant association with exercise capacity in both male and female HCM patients (for females, β=0.27, P=0.001; for males, β=0.27, P<0.001), independent of LV diastolic dysfunction and stroke volume.

Conclusions: Gender-related differences in LA reservoir strain were increasingly evident for older HCM patients aged 60 years and older. LA reservoir strain was an independent determinant of percent-predicted peak VO₂ in male and female patients, underpinning the importance of LA function in determining exercise capacity in HCM.

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肥厚型心肌病患者左心房应变力学和运动能力的性别差异：克利夫兰诊所的倾向分数匹配研究。

背景：肥厚型心肌病（HCM）的男女患者在生理特征和血液动力学方面存在差异。人们对左心房（LA）应变和运动能力的性别差异知之甚少。本研究旨在评估肥厚型心肌病患者运动能力与心脏功能（包括 LA 功能）之间的性别差异：2015年10月至2019年4月期间，作为一项队列研究的一部分，在一家四级转诊中心前瞻性地招募了532名接受运动负荷超声心动图和心肺运动测试（CPET）的HCM患者。为减少潜在的混杂因素，对420名患者进行了倾向评分（PS）匹配。使用斑点追踪超声心动图评估了 LA 应变力学：大多数患者为男性，占总数的 58%。女性 HCM 患者年龄更大（54±14 岁 vs. 50±15 岁，P=0.002）。经过 PS 匹配后，两性预测的峰值 VO2 百分比相似（67.5%±20.7% vs. 65.8%±21.8%，P=0.41），尽管女性 HCM 患者的峰值 VO2 较低（17.7±5.9 vs. 24.1±8.3 mL/kg/min，Pvs. 12.9±6.4，Pvs. 0.74±0.31，Pvs. 30.9%±9.1%，P=0.03）。研究发现，男性和女性 HCM 患者的 LA 储库应变与运动能力均有显著相关性（女性，β=0.27，P=0.001；男性，β=0.27，PConclusions：在 60 岁及以上的老年 HCM 患者中，LA 储库应变与性别相关的差异越来越明显。LA 储库应变是男性和女性患者预测峰值 VO2 百分比的独立决定因素，这证明了 LA 功能在决定 HCM 运动能力方面的重要性。

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来源期刊

Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

4.20%

发文量

期刊介绍： The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.