Transgender Women Exhibit a Distinct Stress Echocardiography Profile Compared With Age-Matched Cisgender Counterparts: The Mayo Clinic Women’s Heart Clinic Experience

Abstract

Stress echocardiographic (SE) testing is an important modality in cardiovascular risk stratification and obstructive coronary artery disease assessment. Binary sex-based parameters are classically used for the interpretation of these studies, even among transgender women (TGW). Coronary artery disease is a leading cause of morbidity and mortality in this population. Yet, it remains unclear whether TGW exhibit a distinct stress testing profile from their cisgender counterparts. Using a matched case-control study design, the authors compared the echocardiographic stress testing profiles of TGW (n=43) with those of matched cisgender men (CGM; n=84) and cisgender women (CGW; n=86) at a single center. Relevant data, including demographics, comorbidities, and cardiac testing data, were manually extracted from the patients' charts. The prevalence of hypertension and dyslipidemia was similar between TGW and CGW and lower than that of CGM (P=.003 and P=.009, respectively). The majority of comorbidities and laboratory values were similar. On average, TGW had higher heart rates than CGM (P=.002) and had lower blood pressures than CGM and CGW (P<.05). TGW's double product and metabolic equivalents were similar to those among CGW and lower than those of CGM (P=.016 and P=.018, respectively). On echocardiography, left ventricular end-diastolic and end-systolic diameters among TGW were similar to those of CGW but lower than those of CGM (P=.023 and P=.018, respectively). Measures of systolic and diastolic function, except for exercise mitral valve E/e' ratio, which was lower in TGW than CGW (P=.029), were largely similar among the three groups. There was no difference in the wall motion score index, and therefore, no difference in the percentage of positive SE test results. This study shows, for the first time, that TGW have a SE profile that is distinct from that of their cisgender counterparts. Larger, multicenter, prospective studies are warranted to further characterize the SE profile of TGW.