Ejection Fraction In Men Research Articles

Detection of left ventricular dysfunction on axial non-contrast chest CT

PurposeTo evaluate the performance of axial non-contrast CT images in detecting systolic and diastolic left ventricular (LV) dysfunction. MethodThis single-center retrospective study assessed 178 participants who underwent transthoracic ultrasonography and had non-contrast chest CT data within three months of ultrasonography. The patients were divided into LV systolic dysfunction (<52% ejection fraction in men and <54% in women), LV diastolic dysfunction (at least three of the following four criteria were met: average E/e' ratio >14; septal e' <7 cm/s or lateral e' <10 cm/s; peak tricuspid regurgitation velocity >2.8 m/s; or left atrial maximum volume index >34 ml/m2), and normal LV function groups. CT parameters were evaluated as predictive factors for LV dysfunction. These parameters were: I, maximum minor axis diameter of the LV lumen; II, I plus myocardial wall thickness; III, maximum left atrium anteroposterior diameter; IV, maximum transverse cardiac diameter; V, myocardial wall thickness; I-IV divided by maximum medial thoracic diameter; and I-IV divided by anteroposterior thoracic diameter. All parameters were measured on axial images: diameters were maximized. ResultsLV systolic dysfunction was indicated when parameter IV exceeded 131.2 mm with sensitivity and specificity of 71.8% and 77.0%, respectively. Moreover, LV diastolic dysfunction was indicated when parameter III divided by anteroposterior thoracic diameter exceeded 0.165 with sensitivity and specificity of 77.8% and 83.0%, respectively. ConclusionsAxial non-contrast chest CT is useful for detecting LV dysfunction. Even CT scans for other purposes provide LV function information that may lead to appropriate examination.

Pharmacoepidemiological analysis of routine management of heart failure patients in the Russian Federation. Part I

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The study included men and women over 18 years of age with an established class II-IV HF and at least one hospitalization due to acute decompensated HF within 12-month follow-up.Results. The final analysis included 888 patients (men, 52,9%; women, 47,1%; mean age, 69 [61; 78] years). The preserved ejection fraction (EF) was detected in 47,86% of patients, mid-range — in 40,54%, reduced — in 11,6%. Only in 16% of patients, there was improved by 1 or more HF. Hypertension and coronary artery disease were predominant in etiology pattern of HF. Preserved EF was more often detected in women over 60 years of age, with HTN and obesity, as well as with HF with mid-range and reduced EF in men in the same age group. There was sufficient follow-up rate, but the extent examinations do not correspond to the recommended one. The prescription rate of renin-angiotensin-aldosterone system (RAAS) inhibitors corresponds to the recommended one, but there is a high frequency of prescribing angiotensin II receptor blockers (ARBs). The prescription rate of β-blockers and loop diuretics (mainly torasemide) increased in comparison with previous studies, while thiazide diuretics — decreased. In patients with reduced EF, the prescription rate of sacubitril/valsartan was only 14,7%, β-blockers — 83,3%, mineralocorticoid receptor antagonists (MCRA) — 72,5%. In patients with midrange EF, there was a sharp decrease in prescription rate of RAAS inhibitors, β-blockers, MCRA.Conclusion. The practical follow-up of patients with HF differs significantly from clinical guidelines. Due to inadequate pharmacotherapy, as well as insufficient noncompliance with the recommended extent of investigations, 1-year HF therapy does not lead to a pronounced improvement in the patients' class.

Suppression of myofilament cross-bridge kinetic in the heart of orchidectomized rats

AimsThe increased incidence of heart failure with reduced ejection fraction in men compared with women suggests that male sex hormones significantly impact myocardial contractile activation. This study aims to examine associations among molecular alterations, cellular modulations and in vivo cardiac contractile function upon deprivation of testicular hormones. Main methodsMyocardial structure and functions were compared among sham-operated control and twelve-week orchidectomized (ORX) male rats with and without testosterone supplementation. Key findingsEchocardiography and pressure-volume relationships demonstrated a decreased left ventricular ejection fraction compared with sham-operated controls. The percentage of contractility reduction was generally similar to the decrease in tension development detected in both right ventricular trabeculae and skinned isolated left ventricular cardiomyocytes of ORX rats. Reductions in tension cost and the rate constant of tension redevelopment (ktr) in ORX samples suggested a decrease in the rate of cross-bridge formation, reflecting a reduced number of cross-bridges. Slow cross-bridge detachment in ORX rat hearts could result from a shift of myosin heavy chain isoforms towards a slower ATPase activity β-isoform and reductions in the phosphorylation levels of cardiac troponin I and myosin binding protein-C. All the changes in the ORX rat heart, including ejection fractions and myofilament protein expression and phosphorylation, were completed attenuated by a physiological dose of testosterone. SignificanceTestosterone plays a critical role in regulating the mechanical and contractile dynamics of the heart. Deprivation of male sex hormones cause the loss of normal preserved cardiac contractile function leading to a high risk of severe cardiomyopathy progression.

Impact of sex-specific target dose in chronic heart failure patients with reduced ejection fraction.

A recent study suggested that women with heart failure and heart failure reduced ejection fraction might hypothetically need lower doses of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers ( = renin-angiotensin-system inhibitors) and β-blockers than men to achieve the best outcome. We assessed the current medical treatment of heart failure reduced ejection fraction in men and women in a large contemporary cohort and address the hypothetical impact of changing treatment levels in women. This analysis is part of a large contemporary quality of heart failure care project which includes 5320 (64%) men and 3003 (36%) women with heart failure reduced ejection fraction. Detailed information on heart failure therapy prescription and dosage were collected. Women less often received renin-angiotensin-system inhibitors (79% vs 83%, p < 0.01), but more often β-blockers (82% vs 79%, p < 0.01) than men. Differences in guideline-recommended target doses between sexes were relatively small. Implementing a hypothetical sex-specific dosing schedule (at 50% of the current recommended dose in the European Society of Cardiology guidelines in women only) would lead to significantly higher levels of women receiving appropriate dosing (β-blocker 87% vs 54%, p < 0.01; renin-angiotensin-system inhibitor 96% vs 75%, p < 0.01). Most interestingly, the total number of women with >100% of the new hypothetical target dose would be 24% for β-blockers and 52% for renin-angiotensin-system inhibitors, which can be considered as relatively overdosed. In this large contemporary heart failure registry, there were significant but relatively small differences in drug dose between men and women with heart failure reduced ejection fraction. Implementation of the hypothetical sex-specific target dosing schedule would lead to considerably more women adequately treated. In contrast, we identified a group of women who might have been relatively overdosed with increased risk of side-effects and intolerance.

Low‐dose Lithium is Associated with Left Ventricular Ejection Fraction in Healthy Young Men but not Women

The impact of lithium (Li) exposure on the cardiovascular system is perplexing, as beneficial, negative, and null effects have been identified. Li is an inhibitor of glycogen‐synthase kinase 3β (GSK3‐β) which has been identified as a possible therapeutic target for cardiovascular disease (CVD) and mental health disorders. While earlier ecological studies suggest that trace amounts of Li may protect against CVD, no study to date has investigated the effects of low‐dose Li exposure on cardiac structure and function in healthy young adults without CVD and whether these associations are sex dependent. The purpose of the present investigation was to examine the association between Li exposure and left ventricular mass (LVM) and function in healthy young adults. This investigation represents a cross‐sectional analysis of the Niagara Longitudinal Heart Study (NLHS) at the midpoint of data collection for 156 participants aged 19 – 25 years. A final sample size of 117 had both valid Li and left ventricular data upon analyses. LVM was indexed to height2.7 (LVMi), ejection fraction (EF), fractional shortening (FS), and stroke volume (SV) were assessed following echocardiography in the parasternal long‐axis view of the left ventricle. Serum Li levels were measured using inductively‐coupled plasma mass spectrometry. Li concentration was significantly associated with EF (r = −0.183, p = 0.05) and ESV (r = 0.197, p = 0.03) among the total sample. Li concentration did not differ when examined by sex (p &gt; 0.05), however LVMi, ESV, EDV, SV, and EF were all significantly higher in males than females (p &lt; 0.05). Li was only significantly correlated with EF in men (r = −0.320, p = 0.02) however no correlation was observed among women (p &gt; 0.05). The novel result of our investigation was naturally occurring concentration of Li is associated with decreased EF in men, but not women, although, there was no significant difference in SV. Further, there was no effect of low‐dose Li on LVMi. This is in contrast to some animal studies which demonstrate long‐term exposure to Li has potent hypertrophic effect on the left ventricle, although, Li concentrations in our sample were considerably lower and fall within a normal physiological range. These findings may result from differential sensitivities of the GSK‐3β receptor to Li in the left ventricle in men and women, although further investigation is required.Support or Funding InformationThis research project is funded by the Canadian Institutes of Health Research (CIHR #s 363774, 399332). KSD is funded by a CIHR Doctoral Research Award – Frederick Banting and Charles Best Canada Graduate Scholarship (RFN#167014). VAF is supported by a Brock Explore Grant and an NSERC Discovery Grant (2019‐05833).

Cardiac left ventricular ejection fraction in men and women with schizophrenia on long-term antipsychotic treatment

Patients with schizophrenia exhibit a higher cardiovascular mortality compared to the general population which has been attributed to life-style factors, genetic susceptibility and antipsychotic medication. Recent echocardiographic studies have pointed to an association between clozapine treatment and reduced left ventricular ejection fraction (LVEF), a measure that has been inversely associated with adverse outcomes including all-cause mortality. Cardiovascular magnetic resonance (CMR) is considered the reference method for LVEF measurement. The aim of the present study was to investigate the LVEF in patients with schizophrenia on long-term treatment with antipsychotics and healthy controls. Twenty-nine adult patients with schizophrenia on long-term medication with antipsychotics and 27 age-, sex- and body mass index-matched healthy controls (mean ages 44 and 45 years, respectively) were recruited from outpatient psychiatric clinics in Uppsala, Sweden. The participants were interviewed and underwent physical examination, biochemical analyses, electrocardiogram and CMR. Men with schizophrenia on long-term antipsychotic treatment showed significantly lower LVEF than controls (p = 0.0076), whereas no such difference was evident among women (p = 0.44). Specifically, clozapine-treated male patients had 10.6% lower LVEF than male controls (p = 0.0064), whereas the LVEF was 5.5% below that of controls among male patients treated with non-clozapine antipsychotics (p = 0.047). Among medicated men with schizophrenia, we found significantly lower LVEF compared to healthy individuals, suggesting the need of routine cardiac monitoring in this patient group. This is the first study showing a significant negative association between treatment with non-clozapine antipsychotics and LVEF.

Abstract 490: Sex-Specific Inflammatory Gene Expression in the Hypertrophied and Failing Human Heart

Heart failure (HF) is a devastating syndrome with poor prognosis that is most often preceded by a left ventricular (LV) pressure overload (PO) disorder, such as aortic stenosis (AS). As pressure inside the LV increases, LV hypertrophy (LVH) develops. Persistent inflammation is known to be detrimental to the heart, which might promote HF. LVH manifests differently between men and women and there are pronounced sex differences in disease progression and outcome. However, the mechanisms that cause these differences are poorly understood. Hypothesizing significant sex differences, we aimed at studying the expression of inflammatory and remodeling genes in cardiomyocytes (CMs) isolated from the LV septum of AS patients ( n = 34; 50% men; 67.5 ± 9.6 years old) undergoing aortic valve replacement. Echocardiography was performed 1 week before surgery and 20.06 ± 9.7 days after surgery. Ethics committee approval and patient consent were obtained. There was no significant difference between men and women in age, body mass index, systolic and diastolic blood pressure, co-morbidities and medication. Posterior wall thickness ( P = 0.02), LV end diastolic diameter ( P = 0.007) and mass index ( P = 0.03) were higher in men than women. Preoperative ejection fraction (EF) was significantly lower in men than women ( P = 0.01). Postoperative EF levels improved in men reaching those of women. Compared to female CMs, male CMs had significantly higher levels of CTGF ( P = 0.03) and NFKB1 ( P = 0.01), as well as ACTC1 ( P = 0.03), GATA4 ( P = 0.03), GJA1 ( P = 0.03), MYH6 ( P = 0.02), MYL4 ( P = 0.03), NPPA ( P = 0.03) and NPPB ( P = 0.05). We found a negative association between gene expression and postoperative EF in men only for GATA4 ( r = -0.77, P = 0.01), GJA1 ( r = -0.69, P = 0.03), MYH6 ( r = -0.69, P = 0.04), MYH7 ( r = -0.82, P = 0.008), MYL4 ( r = -0.71, P = 0.03), NPPA ( r = -0.9, P = 0.001) and NPPB ( r = -0.79, P = 0.01). In end-stage HF, the levels of the chemokine receptor CXCR4 were higher ( P = 0.04) in LV samples of female ( n = 5) vs. male ( n = 4) patients. Collectively, in PO and HF, the expression of inflammatory and remodeling genes is regulated in a sex-specific manner, which may contribute to the mechanisms underlying sex differences in disease progression and outcome.

Opportunistic screening models for high-risk men and women to detect diastolic dysfunction and heart failure with preserved ejection fraction in the community.

BackgroundThe prevalence of undetected left ventricular diastolic dysfunction is high, especially in the elderly with comorbidities. Left ventricular diastolic dysfunction is a prognostic indicator of heart failure, in particularly of heart failure with preserved ejection fraction and of future cardiovascular and all-cause mortality. Therefore we aimed to develop sex-specific diagnostic models to enable the early identification of men and women at high-risk of left ventricular diastolic dysfunction with or without symptoms of heart failure who require more aggressive preventative strategies.DesignIndividual patient data from four primary care heart failure-screening studies were analysed (1371 participants, excluding patients classified as heart failure and left ventricular ejection fraction <50%).MethodsEleven candidate predictors were entered into logistic regression models to be associated with the presence of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in men and women separately. Internal-external cross-validation was performed to develop and validate the models.ResultsIncreased age and β-blocker therapy remained as predictors in both the models for men and women. The model for men additionally consisted of increased body mass index, moderate to severe shortness of breath, increased pulse pressure and history of ischaemic heart disease. The models performed moderately and similarly well in men (c-statistics range 0.60–0.75) and women (c-statistics range 0.51–0.76) and the performance improved significantly following the addition of N-terminal pro b-type natriuretic peptide (c-statistics range 0.61–0.80 in women and 0.68–0.80 in men).ConclusionsWe provide an easy-to-use screening tool for use in the community, which can improve the early detection of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in high-risk men and women and optimise tailoring of preventive interventions.

Sex‐Specific Gene Expression in Isolated Human Cardiomyocytes under Pressure Overload

Cardiac hypertrophy manifests differently between men and women and there are pronounced sex differences in disease progression and outcome. To better understand remodeling and elucidate underlying mechanisms, most approaches have been limited to animal models or multicellular tissue samples. However, little is known about the role of biological sex in remodeling of human cardiomyocytes. We aimed at studying gene expression in isolated human cardiomyocytes under pressure overload hypothesizing significant sex differences. Cardiomyocytes were isolated from the left ventricular (LV) septum of aortic stenosis patients (n = 34; 50% men; 67.5 ± 9.6 years old) undergoing surgical aortic valve replacement. Patients underwent 2D‐guided M‐mode transthoracic echocardiography during the week before surgery and 20.06 ± 9.7 days after surgery. We measured with qRT‐PCR structural genes, as they are involved in cardiac hypertrophy and remodeling, thereby influencing cardiac function. The study was conducted in conformance with the Basic Principles of the Declaration of Helsinki. There was no significant difference between men and women in age, body mass index, systolic and diastolic blood pressure, co‐morbidities and medication. Preoperative posterior wall thickness (P = 0.02), LV end diastolic diameter (P = 0.007) and mass index (P = 0.03) were higher in men than women. At similar levels of aortic valve area index between the sexes, preoperative ejection fraction (EF) was significantly lower in men than women (P = 0.01). Postoperative EF levels improved in men reaching those of women. Male cardiomyocytes had significantly higher levels of ACTC1 (P = 0.03), CTGF (P = 0.03), GATA4 (P = 0.03), GJA1 (P = 0.03), MYH6 (P = 0.02), MYL4 (P = 0.03), NFKB1 (P = 0.01), NPPA (P = 0.03) and NPPB (P = 0.05) than female cardiomyocytes. Next, we asked whether there is an association between gene expression and postoperative EF. The expression of GATA4 (r = −0.77, P = 0.01), GJA1 (r = −0.69, P = 0.03), MYH6 (r = −0.69, P = 0.04), MYH7 (r = −0.82, P = 0.008), MYL4 (r = −0.71, P = 0.03), NPPA (r = −0.9, P = 0.001) and NPPB (r = −0.79, P = 0.01) was negatively correlated with postoperative EF in men only. In conclusion, gene expression is regulated in a sex‐specific manner in isolated cardiomyocytes of aortic stenosis patients. Compared with women, men had higher levels of maladaptive remodeling factors, which may be part of the molecular mechanisms underlying the observed sex differences in cardiac function, i.e. EF. Given the male‐specific changes in EF postoperatively, cardiomyocyte‐specific gene regulation at the time of surgery might inform disease progression.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Genderspecific risk factors and outcomes of ischemic heart disease

Objective. To study the relationship of gender with the risk factors for coronary artery disease and adverse long-term outcomes in patients with acute coronary syndrome without ST segment elevation (nonST-ACS). Results. Women were older than men, significantly more likely had arterial hypertension and diabetes, but six times less smoked. Coronary artery stenosis &gt;50% in history occurred in men more often than women: 24.2% vs. 11.7%. The median value of the left ventricular ejection fraction in men was significantly lower than in women (56 (49; 63) vs. 60 (50; 64.7), p=0.028). Men were significantly more likely to have a low risk (39.6% versus 24.5%, p=0.0027), and women had a high risk on the GRACE scale (35% versus 21.6%, p=0.0053). Women significantly (p&lt;0.001) were less likely to undergo coronary angiography, while coronary artery stenosis was more frequent (p&lt;0.001) in men than in women. The median scores on the Syntax score were significantly (p&lt;0.001) lower in women - 9.5 (6; 16.5) compared to the same in men - 14 (7; 22). PCI was performed significantly more often in men (p&lt;0.001). Differences in the incidence of adverse cardiovascular events during the five-year follow-up period after discharge after index nonST-ACS for men and women have not been identified. Conclusion. Women with nonST-ACS have more cardiovascular risk factors, in this case, the incidence of adverse cardiovascular events is the same as men with less pronounced coronary lesions, so need to use more actively invasive strategy of women during the index hospitalization.

Abstract 386: Sex Differences in Vitamin D Alter Inflammation During Heart Disease

An estimated 1 billion people worldwide have deficient or insufficient levels of vitamin D (VitD). Considerable evidence indicates that VitD deficiency is associated with an increased risk of autoimmune and cardiovascular disease (CVD), yet it remains unclear whether low VitD is simply a biomarker or has a true pathologic role. In this study we examined how sex differences in VitD influences various CVDs. We found that patients with CVD had significantly lower VitD than healthy controls (no ICD9/10 codes). In myocarditis patients low VitD correlated to poor ejection fraction (EF) in women with myocarditis (p=0.02), but high VitD correlated with low EF in men (p=0.04). In VDR knockout mice we found that VDR decreased myocarditis in females (p=2E-8) but increased inflammation in males (p=0.03) with an increase in total immune cells (p=0.02), CD3, CD4 and CD8 T cells (p=0.04), and the inflammasome in females. VDR altered Treg (p=0.04), mast cells (p=0.04) and cytokine profiles in males. Additionally, sera VitD levels were significantly higher in WT male mice with myocarditis compared to females. Our findings in VDR mice indicate that VitD/VDR reduces myocarditis in females, but increases disease in males. These data suggest that VitD sufficiency may increase inflammation in men, while VitD deficiency may make disease worse in women. These findings suggest that Vitamin D may have a role in the pathogenesis of inflammatory and cardiovascular disease.

The prevalence of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in men and women with type 2 diabetes: A systematic review and meta-analysis.

Objective:Type 2 diabetes is a risk factor for the development of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction. Our aim was to provide a summary estimate of the prevalence of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in type 2 diabetes patients and to investigate sex disparities.Methods and results:A systematic search of the databases Medline and Embase was conducted for studies reporting the prevalence of left ventricular diastolic dysfunction or heart failure with preserved ejection fraction among type 2 diabetes patients. Studies were only included if echocardiography was performed. Prevalence estimates were pooled using random-effects meta-analysis. A total of 28 studies were included. Data on the prevalence of left ventricular diastolic dysfunction were available in 27 studies. The pooled prevalence for left ventricular diastolic dysfunction in the hospital population (2959 type 2 diabetes participants) and in the general population (2813 type 2 diabetes participants) was 48% [95% confidence interval: 38%–59%] and 35% (95% confidence interval: 24%–46%), respectively. Heterogeneity was high in both populations, with estimates ranging from 19% to 81% in the hospital population and from 23% to 54% in the general population. For women and men, the pooled prevalence estimates of left ventricular diastolic dysfunction were 47% (95% confidence interval: 37%–58%) and 46% (95% confidence interval: 37%–55%), respectively. Only two studies presented the prevalence of heart failure with preserved ejection fraction; 8% (95% confidence interval: 5%–14%) in a hospital population and 25% (95% confidence interval: 21%–28%) in the general population [18% in men (mean age: 73.8; standard deviation: 8.6) and 28% in women (mean age: 74.9; standard deviation: 6.9)].Conclusion:The prevalence of left ventricular diastolic dysfunction among type 2 diabetes patients is similarly high in men and women, while heart failure with preserved ejection fraction seems to be more common in women than men, at least in community people with type 2 diabetes.

Sex differences in Vitamin D alter inflammation during heart disease

Abstract An estimated 1 billion people worldwide have deficient or insufficient levels of vitamin D (VitD). Considerable evidence indicates that VitD deficiency is associated with an increased risk of autoimmune and cardiovascular disease (CVD), yet it remains unclear whether low VitD is simply a biomarker or has a true pathologic role. In this study we examined how sex differences in VitD influences various CVDs. We found that patients with CVD had significantly lower VitD than healthy controls (no ICD9/10 codes) (p=4E-6). In myocarditis patients low VitD correlated to poor ejection fraction (EF) in women with myocarditis (p=0.02), but high VitD correlated with low EF in men (p=0.04). In VDR knockout mice we found that VDR decreased myocarditis in females (p=2E-8) but increased inflammation in males (p=0.03) with an increase in total immune cells (p=0.02), CD3, CD4 and CD8 T cells (p=0.04), and the inflammasome in females. VDR altered Treg (p=0.04), mast cells (p=0.04) and cytokine profiles in males. Additionally, sera VitD levels were significantly higher in WT male mice with myocarditis compared to females. Our findings in VDR mice indicate that VitD/VDR reduces myocarditis in females, but increases disease in males. These data suggest that VitD sufficiency may increase inflammation in men, while VitD deficiency may make disease worse in women. These findings suggest that Vitamin D may have a role in the pathogenesis of inflammatory and cardiovascular disease.

Prevalence of left ventricular systolic dysfunction and heart failure with reduced ejection fraction in men and women with type 2 diabetes mellitus: a systematic review and meta-analysis.

BackgroundType 2 diabetes mellitus (T2D) is associated with the development of left ventricular systolic dysfunction (LVSD) and heart failure with reduced ejection fraction (HFrEF). T2D patients with LVSD are at higher risk of mortality and morbidity than patients without LVSD, while progression of LVSD can be delayed or halted by the use of proven therapies. As estimates of the prevalence are scarce and vary considerably, the aim of this study was to retrieve summary estimates of the prevalence of LVSD/HFrEF in T2D and to see if there were any sex differences.MethodsA systematic search of Medline and Embase was performed to extract the prevalence of LVSD/HFrEF in T2D (17 studies, mean age 50.1 ± 6.3 to 71.5 ± 7.5), which were pooled using random-effects meta-analysis.ResultsThe pooled prevalence of LVSD was higher in hospital populations (13 studies, n = 5835, 18% [95% CI 17–19%]), than in the general population (4 studies, n = 1707, 2% [95% CI 2–3%]). Seven studies in total reported sex-stratified prevalence estimates (men: 7% [95% CI 5–8%] vs. women: 1.3% [95% CI 0.0.2.2%]). The prevalence of HFrEF was available in one general population study (5.8% [95% CI 3.7.6%], men: 6.8% vs. women: 3.0%).ConclusionsThe summary prevalence of LVSD is higher among T2D patients from a hospital setting compared with from the general population, with a higher prevalence in men than in women in both settings. The prevalence of HFrEF among T2D in the population was only assessed in a single study and again was higher among men than women.

Subclinical changes in MRI-determined right ventricular volumes and function in subjects with prediabetes and diabetes.

The aim of this study was to assess subclinical changes in right ventricular volumes and function in subjects with prediabetes and diabetes and controls without a history of cardiovascular disease. Data from 400 participants in the KORA FF4 study without self-reported cardiovascular disease who underwent 3-T whole-body MRI were obtained. The right ventricle was evaluated using the short axis and a four-chamber view. Diabetes was defined according to WHO criteria. Associations between glucose tolerance and right ventricular parameters were assessed using multivariable adjusted linear regression models. Data from 337 participants were available for analysis. Of these, 43 (13%) had diabetes, 87 (26%) had prediabetes, and 207 (61%) were normoglycaemic controls. There was a stepwise decrease in right ventricular volumes in men with prediabetes and diabetes in comparison with controls, including right ventricular end-diastolic volume (β = -20.4 and β = -25.6, respectively; p ≤ 0.005), right ventricular end-systolic volume (β = -12.3 and β = -12.7, respectively; p ≤ 0.037) and right ventricular stroke volume (β = -8.1 and β = -13.1, respectively, p ≤ 0.016). We did not observe any association between prediabetes or diabetes and right ventricular volumes in women or between prediabetes or diabetes and right ventricular ejection fraction in men and women. This study points towards early subclinical changes in right ventricular volumes in men with diabetes and prediabetes. • MRI was used to detect subclinical changes in right ventricular parameters. • Diabetes mellitus is associated with right ventricular dysfunction. • Impairment of right ventricular volumes seems to occur predominantly in men.

Is There a Sex-Related Difference in the Obesity Paradox in Systolic Heart Failure? Sex-Related Difference in the Obesity Paradox.

PurposeObesity is often associated with better clinical outcomes in heart failure (HF). This so-called obesity paradox remains controversial. The aim of present study was to investigate the prognostic value of obesity in patients hospitalized for systolic HF.Materials and MethodsWe performed a pooled analysis of data from two multicenter, observational HF studies. Patients hospitalized for systolic HF were eligible for the present study. We divided the subjects into two groups, a normal body mass index (BMI) group and a high BMI group. Study endpoints included all-cause mortality and any re-hospitalization within 1 year.ResultsWe enrolled 3145 patients (male, 1824; female, 1321). The high BMI group was significantly associated with lower 1-year mortality rate [odds ratio (OR), 0.543; 95% confidence interval (CI), 0.355−0.832] after adjusting for age, hypertension, diabetes, ischemic HF, previous myocardial infarction, serum creatinine level, anemia, and ejection fraction in men. After adjustment for clinical characteristics, high BMI was not significantly associated with 1-year mortality (OR, 0.739; 95% CI, 0.450−1.216) or 1-year re-hospitalization (OR, 0.958; 95% CI, 0.696−1.319) in women.ConclusionIn pooled analysis of data from two Korean HF registries, the high BMI group was independently associated with lower 1-year mortality rate from systolic HF, especially in men.

Low-grade inflammation and endothelial dysfunction explain the association between retinopathy and left ventricular ejection fraction in men: an 8-year follow-up of the Hoorn Study

PurposeThe aim of this study was to prospectively investigate the association of retinopathy with changes in left ventricular (LV) function. MethodsWithin the Hoorn Study, a population-based cohort study of diabetes in The Netherlands, retinal photography and echocardiography were performed in the year 2000 (baseline) and 2008 (follow-up). Retinopathy was graded according to the Eurodiab classification and further defined as absent or present retinopathy. LV systolic and diastolic functions were assessed by LV ejection fraction (%), LV mass (g/m2.7) and left atrial (LA) volume indices and the ratio of LV inflow (E) and early diastolic lengthening (e’) velocities. Linear regression analyses stratified for sex were completed to investigate associations of retinopathy with changes in LV function in participants with impaired glucose metabolism and type 2 diabetes. ResultsOne hundred forty-seven participants (58% men, mean age 66) were included in the study, of whom 13.6% were present with retinopathy at baseline. LV ejection fraction was similar among participants with and without retinopathy (60.2% versus 60.7%) at baseline. Eight years later, retinopathy was significantly associated with a lower LV ejection fraction (β -8.0 95% CI −15.37 to −0.68) in men, independent of risk factors. Microvascular endothelial dysfunction ([ED] β -4.87 95% CI −13.40 to 3.67) and low-grade inflammation ([LGI] β −5.30 95% CI −13.72 to 3.12) both diminished the association. No significant associations between retinopathy and other LV function parameters were observed. ConclusionRetinopathy was significantly associated with a lower LV ejection fraction in men but not in women. LGI and ED might explain the observed association.

Sex-specific biatrial volumetric measurements obtained with use of multidetector computed tomography in subjects with and without coronary artery disease.

Atrial volumetric measurement has proven clinical implications. Advances in cardiac imaging, notably the precision enabled by multidetector computed tomography (MDCT), herald the need for new criteria of what constitutes normal volumetric measurements. With use of 64-slice MDCT, we compared the atrial volumes in healthy individuals with those in individuals with coronary artery disease. By means of manual segmentation, we measured biatrial volume in 686 participants who underwent retrospective electrocardiographic-gated MDCT angiographic evaluation. The study population included a control group of 203 persons with no cardiac abnormalities, and a study group of 483 patients with obstructive coronary artery disease. All variables were compared between men and women and between the groups. We found a significant difference in left atrial end-systolic and end-diastolic volumes between men and women in the control group (P <0.05); however, right atrial volumes were similar. In comparison with the entire control group, the coronary artery disease group had significantly higher left atrial volume, significantly lower right atrial stroke volume, and significantly lower biatrial ejection fraction, except for left atrial ejection fraction in men. Right atrial volume and left atrial stroke volume were not significantly different. The results imply that a sex-specific reference value is necessary for left atrial volumetric evaluation, and that left atrial volume and biatrial ejection fraction (excluding left atrial ejection fraction in men) might be useful during diagnosis and prognosis in patients who have coronary artery disease.

Association between erectile dysfunction and echocardiographic variables of ventricular hypertrophy and diastolic function in hypertensive patients with type 2 diabetes mellitus: A cross‐sectional study 在合并2型糖尿病的高血压患者中勃起功能障碍与心室肥厚以及舒张功能超声心动图变量之间的关系：一项横断面研究

AbstractBackgroundThis study was conducted among individuals with diabetes and hypertension in order to assess the prevalence of erectile dysfunction (ED) and the association between ED and cardiovascular risk variables such as echocardiographic changes.MethodsWe evaluated 114 men with type 2 diabetes mellitus and hypertension. ED was assessed by International Index of Erectile Function (IIEF‐5) score. Clinical and laboratory variables were evaluated, including C‐reactive protein (CRP), ambulatory blood pressure monitoring (ABPM), ankle brachial index (ABI) and transthoracic echocardiography. Comparisons between patients with ED (IIEF‐5 &lt; 22) and without ED (IIEF‐5 ≥ 22) were performed.ResultsPatients were 56.8 ± 5.7 years‐old, systolic and diastolic blood pressure were 150.7 ± 19.5 mmHg and 85.4 ± 11.4 mmHg, respectively, and HbA1c was 8.0 ± 1.7%. The majority (74.6%) of patients had ED. Levels of CRP, ABPM values and ABI were similar between men with and without ED. Echocardiography variables related to cardiac chamber diameters, left ventricular hypertrophy and diastolic function were similar between groups, except there was a slight lower left ventricular ejection fraction in men with ED (64.9 ± 7.3 vs 68.1 ± 3.9%, P = 0.004).ConclusionsIn high cardiovascular risk hypertensive individuals with type 2 diabetes, ED is highly prevalent as expected, but its presence is associated with neither echocardiographic variables, nor other cardiovascular risk factors.

Associations of Plasma Phospholipid Omega-6 and Omega-3 Polyunsaturated Fatty Acid Levels and MRI Measures of Cardiovascular Structure and Function: The Multiethnic Study of Atherosclerosis

Background. The association between plasma omega-6 fatty acids and cardiovascular disease (CVD) is unclear, and discrepancy remains concerning the cardiovascular benefit of the omega-3 fatty acid alpha-linolenic acid. Methods. Associations of plasma phospholipid fatty acid levels (arachidonic acid, linoleic acid, eicosapentaenoic acid, docosahexaenoic acid (DHA), and alpha-linolenic acid) with cardiac magnetic resonance imaging measures of left ventricular (LV) mass, LV volume, ejection fraction, stroke volume, and aortic distensibility were investigated in 1,274 adults. Results. Results of multivariate analysis showed no statistically significant associations of plasma omega-6 or omega-3 levels with cardiac magnetic resonance imaging measures. Stratification by gender revealed a positive association between DHA and LV mass in women (β = 1.89, P = 0.02; P interaction = 0.003) and a trend for a positive association between DHA and ejection fraction in men (β = 0.009, P = 0.05; P interaction = 0.03). Conclusion. Additional research is warranted to clarify the effects of plasma DHA on cardiac structure and function in women versus men.