Young males with pulmonary arterial hypertension have a high afterload and low right ventricular ejection fraction at presentation

Abstract

Background: Gender is known to play a role in right ventricular (RV) adaption in pulmonary arterial hypertension (PAH). Sex hormone levels change with aging both in males and females. However effect of aging on RV function within sexes has not been explored. Aim: To study the effect of age on PAH disease severity and RV adaptation in both sexes. Methods: Systolic elastance (Ees), arterial elastance (Ea), diastolic elastance (Eed) and RV-arterial coupling (Ees/Ea) were determined in 88 newly diagnosed, treatment naive, idiopathic and hereditary PAH patients using the single-beat pressure volume analysis. Right ventricular ejection fraction (RVEF) was determined by CMR. Both males and females were divided in an age ≤50 and age > 50 years group, as 50 years is the mean age women reach the menopause. Results: Results are presented in figure 1. Ees (p=0.56), Ea (p=0.40), Ees/Ea (p=0.87) or Eed (p=0.67) were not related to age in women. However, young men presented with a higher afterload (p =0.0006) when compared to men>50 years old. In addition, baseline RVEF was lower in young men compared to men>50 years (21%±11.7 vs. 35%±12.4, p=0.0431). Conclusion: Young males with PAH presented with a high afterload and low RVEF. Further research in a larger cohort is warranted to elucidate whether this is a consequence of a distinct disease phenotype.