Abstract 11702: Sex Differences in Diabetic Cardiomyopathy: Greater Reduction in Myocardial Perfusion Reserve in Women Than Men Driven by Increased Resting Perfusion

Abstract

Introduction: Type 2 diabetes (T2D) confers a higher relative risk of heart failure in women than men. Women also have a greater prevalence of heart failure with preserved ejection fraction (HFpEF), linked to microvascular dysfunction. We hypothesize that sex-specific differences are present in the pathophysiological alterations of myocardial structure, function, and perfusion associated with T2D. Methods: Cross-sectional case-control study. Participants underwent comprehensive cardiac phenotyping with echocardiography and cardiac magnetic resonance with adenosine stress/rest perfusion. Global myocardial perfusion was derived as a mean of three short axis slices. Image analysis was performed by two observers blinded to all participant information. Statistical analysis was performed with independent-sample T-tests or Mann-Whitney test. Results: Individuals with T2D (n=287, 41% female) were compared with age-matched controls (n=87, 41% female). Women with T2D were more obese than men (body mass index 35.7±7.2 vs 32.4±5.3 kg/m 2 , p<0.05). Both women and men with T2D had increased left ventricular (LV) concentric remodelling (greater LV mass/volume ratio), impaired diastolic (higher E/e’) and systolic (lower global longitudinal strain) function compared to controls. LV mass index was significantly increased in women only. Comparing T2D and controls, stress perfusion was not significantly different in both sexes whereas resting perfusion was increased in women (1.4±0.6 vs 1.0±0.4 ml/min/g, p<0.05) but not in men. Consequently, women with T2D have a lower myocardial perfusion reserve than men (2.6±0.9 vs 3.1±0.9, p<0.001). Conclusions: In asymptomatic people with T2D, women have increased LV mass index and lower myocardial perfusion reserve than men, driven primarily by increased resting perfusion. These findings support the growing evidence that microvascular dysfunction partly explains the greater risk of HFpEF in women with T2D.