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De Maria B, Parati M, Dalla Vecchia LA, La Rovere MT. Day and night heart rate variability using 24-h ECG recordings: a systematic review with meta-analysis using a gender lens. Clin Auton Res 2023; 33:821-841. [PMID: 37541968 PMCID: PMC10751261 DOI: 10.1007/s10286-023-00969-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE Increasing evidence demonstrates that gender-related factors, and not only biological sex, are relevant in the physiological and pathophysiological mechanisms of the cardiovascular system, including the cardiac autonomic regulation. Sex and gender may also affect daytime and night-time cardiac autonomic control. This meta-analysis aimed to provide a comparison between healthy women and men on heart rate variability using 24-h ECG recordings pointing out sex- and gender-related factors. METHODS A systematic search was conducted to include studies focusing on both sex and gender differences related to heart rate variability indices in the time and frequency domains. Descriptive data were extracted by two independent reviewers. For each index, standardized mean differences with 95% confidence intervals were computed and a pooled estimate using a fixed- or random-effects model was applied. RESULTS Twenty-seven studies were included in the meta-analysis. The results showed that only seven studies reported some information about gender-related factors. Concerning sex-related differences, women had a shorter mean RR interval and lower variability of the time domain indices than men. Sex-related differences concerning frequency domain indices were more evident during night-time compared to daytime. CONCLUSION The characterization of gender-related factors in the study of heart rate variability using 24-h ECG recordings is still sporadic and underexplored. The meta-analysis results could not conclusively support a significant increase of high frequency power in women, although women showed a reduced total power and low frequency to high frequency ratio. There is a strong need for considering heart rate variability in relation to gender-related variables.
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Affiliation(s)
- Beatrice De Maria
- Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138, Milano, Italy
| | - Monica Parati
- Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138, Milano, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Elsayegh AT, Nazmi H, Attia HM, Kamel H. Gender differences in two-dimensional and three-dimensional speckle tracking echocardiography left ventricular measurements among healthy preschool pediatric population. Egypt Heart J 2023; 75:57. [PMID: 37405547 DOI: 10.1186/s43044-023-00380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Speckle-tracking echocardiography (STE) is an upcoming echocardiographic modality to measure global as well as segmental left ventricular systolic function expressed numerically as strain values independent of angle and ventricular geometry. We conducted this prospective study on 200 healthy preschool children with structurally normal hearts, to determine gender-based differences in two-dimensional (2D) global longitudinal strain (GLS) and three-dimensional (3D) GLS. RESULTS Age-matched 104 males and 96 females were included, 2D GLS results for the males showed longitudinal strain ranging from - 18.1 to - 29.8 with a mean of - 21.7202 ± 5.094322, while for females 2D GLS ranged from - 18.1 to - 30.7 with a mean of - 22.0646 ± 2.167802, also 3D GLS values were measured and compared based on gender, where 3D GLS in males ranged from - 18 to - 24 with a mean value of 20.49 ± 1.28, while for females ranged from - 17 to - 30 with a mean value of 20.47 ± 1.755. The gender-based difference for both 2D GLS and 3D GLS showed non-significant P values. CONCLUSION In healthy subjects below 6 years, 2D STE and 3D STE values showed no difference between males and females, unlike the adult population, to the best of our knowledge, this is one of the few studies in the literature that aims at comparing these measurements in the healthy pediatric group. In routine clinical practice, these values may be used to assess myocardial function or the early signs of malfunction.
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Affiliation(s)
- Ayah Tarek Elsayegh
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, 38 Abbassia, Next to the Al-Nour Mosque, Cairo, 1181, Egypt.
| | - Hany Nazmi
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, 38 Abbassia, Next to the Al-Nour Mosque, Cairo, 1181, Egypt
| | - Hebatallah Mohamed Attia
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, 38 Abbassia, Next to the Al-Nour Mosque, Cairo, 1181, Egypt
| | - Heba Kamel
- Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University Hospital, 38 Abbassia, Next to the Al-Nour Mosque, Cairo, 1181, Egypt
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3
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Zhang Z, Ma Q, Gao Y, Cao L, Zhu C, Zhao Z, Zhao J, Zeng L, Lou M, Pohost GM, Li K. Biventricular Morphology and Function Reference Values Derived From a Large Sample of Healthy Chinese Adults by Magnetic Resonance Imaging. Front Cardiovasc Med 2021; 8:697481. [PMID: 34350219 PMCID: PMC8326328 DOI: 10.3389/fcvm.2021.697481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Quantification of cardiac structure and function is essential for diagnostic interpretation and clinical decision making. We sought to establish cardiovascular magnetic resonance (CMR) reference values of left and right ventricular (LV and RV) morphology and function based on a large sample of healthy Chinese adults. Methods: Five hundred fifty validated healthy Chinese adults (aged 21-70 years; 323 men) free of hypertension, diabetes, and obesity were included in this study. All the subjects were stratified by gender (men and women) and age decades. On cine CMR, measurements of biventricular end-diastolic, end-systolic, and stroke volumes (EDV, ESV, and SV), ejection fraction (EF), and end-diastolic LV wall thickness (LVWT) and mass (LVM) were obtained. Results: Men had greater LVEDV (111.6 ± 19.8 vs. 94.6 ± 15.6 ml), LVESV (36.5 ± 9.8 vs. 28.2 ± 7.9 ml), LVM (121.1 ± 19.9 vs. 86.1 ± 14.5 g), global end-diastolic LVWT (8.1 ± 1.1 vs. 6.7 ± 1.0 mm), RVEDV (128.0 ± 23.6 vs. 101.7 ± 17.0 ml), and RVESV (53.5 ± 13.7 vs. 36.8 ± 8.9 ml), while women had greater LVEF (67.5 ± 5.4 vs. 70.4 ± 5.7%) and RVEF (58.5 ± 5.2 vs. 64.0 ± 5.3%) (all p < 0.001). For both men and women, age was negatively correlated with LVEDV (r = -0.31 and r = -0.32), LVESV (r = -0.37 and r = -0.47), RVEDV (r = -0.31 and r = -0.29), and RVESV (r = -0.33 and r = -0.44), while it was positively correlated with LVEF (r = 0.28 and r = 0.43) and RVEF (r = 0.28 and r = 0.41) (all p < 0.001). Aging was associated with increasing global end-diastolic LVWT and LVM/LVEDV in both sexes (all p < 0.001). Older age was associated with increasing LVM only in women (r = 0.36, p < 0.001), not in men (r = 0.05, p = 0.359). Conclusions: We systematically provide age-, sex-, and body size-specific CMR reference values for biventricular morphology and function based on a large sample of healthy Chinese adults. Biventricular structure and function are significantly associated with age and sex.
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Affiliation(s)
- Zhen Zhang
- Post-doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Qiaozhi Ma
- Department of Radiology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yiyuan Gao
- Post-doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Lizhen Cao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Zhiwei Zhao
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
| | - Jun Zhao
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
| | - Linan Zeng
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
| | - Mingwu Lou
- Post-doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Gerald M Pohost
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
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Martin J, Coffey S, Whalley GA. Sex Disparity in Cardiovascular Disease Outcomes: Do Our Current Echocardiographic Reference Ranges Measure Up? Heart Lung Circ 2020; 30:e1-e5. [PMID: 33176982 DOI: 10.1016/j.hlc.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
Reducing inequity in access to health care and disparity in health outcomes remain key objectives in cardiovascular medicine. Echocardiography is often the primary diagnostic tool used to detect cardiovascular disease (CVD), and relies on comparison with published reference ranges to appropriately detect pathology. Our understanding of the contribution of age, sex and ethnicity to quantification of cardiac size is improving, but cardiovascular disease management guidelines have yet to evolve. While recently, sex, age and ethnicity-specific reference values have been produced, treatment thresholds in many clinical guidelines do not differentiate between sexes. As a result, in order to reach management thresholds, women are often required to have more severe pathology. In order to reduce potential disadvantage to women, future research efforts should be directed to develop more personalised treatment approaches by identification of sex-appropriate management thresholds.
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Affiliation(s)
- Josh Martin
- Department of Cardiology, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia.
| | - Sean Coffey
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gillian A Whalley
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Kharaba ZJ, Buabeid MA, Alfoteih YA. Effectiveness of testosterone therapy in hypogonadal patients and its controversial adverse impact on the cardiovascular system. Crit Rev Toxicol 2020; 50:491-512. [PMID: 32689855 DOI: 10.1080/10408444.2020.1789944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Testosterone is the major male hormone produced by testicles which are directly associated with man's appearance and secondary sexual developments. Androgen deficiency starts when the male hormonal level falls from its normal range though, in youngsters, the deficiency occurs due to disruption of the normal functioning of pituitary, hypothalamus glands, and testes. Thus, testosterone replacement therapy was already known for the treatment of androgen deficiency with lesser risks of producing cardiovascular problems. Since from previous years, the treatment threshold in the form of testosterone replacement therapy has effectively increased to that extent that it was prescribed for those conditions which it was considered as inappropriate. However, there are some research studies and clinical trials available that proposed the higher risk of inducing cardiovascular disease with the use of testosterone replacement therapy. Thus under the light of these results, the FDA has published the report of the increased risk of cardiovascular disease with the increased use of testosterone replacement therapy. Nevertheless, there is not a single trial available or designed that could evaluate the risk of cardiovascular events with the use of testosterone replacement therapy. As a result, the use of testosterone still questioned the cardiovascular safety of this replacement therapy. Thus, this literature outlines the distribution pattern of disease by investigating the data and link between serum testosterone level and the cardiovascular disease, also the prescription data of testosterone replacement therapy patients and their tendency of inducing cardiovascular disease, meta-analysis and the trials regarding testosterone replacement therapy and its connection with the risks of causing cardiovascular disease and lastly, the possible effects of testosterone replacement therapy on the cardiovascular system. This study aims to evaluate the available evidence regarding the use of testosterone replacement therapy when choosing it as a treatment plan for their patients.
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Affiliation(s)
- Zelal Jaber Kharaba
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Manal Ali Buabeid
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
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6
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Abstract
Testosterone is the main male sex hormone and is essential for the maintenance of male secondary sexual characteristics and fertility. Androgen deficiency in young men owing to organic disease of the hypothalamus, pituitary gland or testes has been treated with testosterone replacement for decades without reports of increased cardiovascular events. In the past decade, the number of testosterone prescriptions issued for middle-aged or older men with either age-related or obesity-related decline in serum testosterone levels has increased exponentially even though these conditions are not approved indications for testosterone therapy. Some retrospective studies and randomized trials have suggested that testosterone replacement therapy increases the risk of cardiovascular disease, which has led the FDA to release a warning statement about the potential cardiovascular risks of testosterone replacement therapy. However, no trials of testosterone replacement therapy published to date were designed or adequately powered to assess cardiovascular events; therefore, the cardiovascular safety of this therapy remains unclear. In this Review, we provide an overview of epidemiological data on the association between serum levels of endogenous testosterone and cardiovascular disease, prescription database studies on the risk of cardiovascular disease in men receiving testosterone therapy, randomized trials and meta-analyses evaluating testosterone replacement therapy and its association with cardiovascular events and mechanistic studies on the effects of testosterone on the cardiovascular system. Our aim is to help clinicians to make informed decisions when considering testosterone replacement therapy in their patients.
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7
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Perrone V, Veronesi C, Nica M, Colombo D, Degli Esposti L, Castello R. Explorative analysis of gender-specific characteristics in patients with heart failure in an Italian hospital. Ther Clin Risk Manag 2019; 15:847-850. [PMID: 31360063 PMCID: PMC6625643 DOI: 10.2147/tcrm.s203011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
Sex-related differences have been shown to deeply affect health-related aspects of patients. However, the lack of gender-specific analysis makes it difficult to advance personalized medicine in terms of a gender-based approach. The aim of the present study was to describe gender-specific features of patients diagnosed with heart failure (HF), with a focus on the clinical presentation. Data were collected from a properly designed database and referred to an Italian hospital. Patients aged ≥18 years with a primary or secondary diagnosis of HF between 1 January 2012 and 31 December 2016 were included, and their demographic and clinical characteristics were analyzed according to gender. Of the 719 HF patients included, 317 (44.1%) were male and 402 (55.9%) were female. Women tended to be older compared to men (82.4±8.8 years and 77.1±10.6 years, respectively). As for clinical presentation, 62.1% of female and 38.3% of male patients had preserved ejection fraction, and 56.1% of men and 58.2% of women suffered from atrial fibrillation. The left atrium was partially compromised in 62.4% of male and 63% of female patients, while right atrium dysfunction tended to be more frequent in male patients compared to female patients (29.1% and 25.5%, respectively). In conclusion, gender-specific features of a cohort of HF patients from a clinical setting were accurately described.
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Affiliation(s)
- V Perrone
- Clicon S.R.L. Health, Economics and Outcomes Research, Ravenna, Italy
| | - C Veronesi
- Clicon S.R.L. Health, Economics and Outcomes Research, Ravenna, Italy
| | - M Nica
- Novartis Pharma, Origgio, VA, Italy
| | | | - L Degli Esposti
- Clicon S.R.L. Health, Economics and Outcomes Research, Ravenna, Italy
| | - R Castello
- Division of General Medicine, University Hospital of Verona, Verona, Italy
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8
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Kerkhof PLM, Heyndrickx GR, Handly N. Heart Failure Phenotypes Require Sex-Specific Criteria Which Are Based on Ventricular Dimensions. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2019:4909-4912. [PMID: 31946961 DOI: 10.1109/embc.2019.8857165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Ejection fraction (EF) is often used as a criterion to establish diagnostic phenotypes of heart failure (HF). Because EF is a derived metric based on end-systolic volume (ESV) and end-diastolic volume (EDV), it is more logical to consider ESV or EDV as cut-off marker. We concentrate on the impact of ESV, which has the advantage of being linearly related to EDV and nonlinearly with EF, both with highly significant correlations. In particular we also analyze if HF classification should distinguish between females and males.ESV and EDV were determined by biplane angiography in 197 HF patients (67 women). As body surface indexed (i) ESVi values for adult healthy females are smaller than for males, we employ classes of ESVi (bins of 10 mL/m2) to group preserved and reduced EF's (cut-off at 50%) for HF. Reference values regarding mean and standard deviation for ESVi are based on a control group (N=155, 65 women) without HF. For interpretation of the findings we use the documented universal relationship connecting EF to ESV: EF = 1 + c1 {ESV / (c2 - ESV)}, where c1 and c2 are population-based sex-independent constants. In the reference group ESVi (mL/m2) in women (27.4 ± 27.6) is smaller (P=0.0026) than in their male counterparts (43.6 ± 37.5). Similarly, for HF the ESVi in women (45.7 ± 41.4) is smaller (P=0.0033) than in men (64.2 ± 41.4). This signifies (see formula above) that women have higher values for EF, primarily resulting from smaller ventricular size related to their sex, and not exclusively reflecting disease state. Current phenotype classification based on pooled data for males and females may be inappropriate for either sex.The significantly smaller ESVi observed in women has direct consequences for the traditional classification based on EF cutoff values for HF. Sex-specific criteria (regarding ESVi or EF) for HF phenotypes are warranted, and expectedly have substantial consequences for identification, classification, and management of HF patients.
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Lo Muzio FP, Rozzi G, Rossi S, Gerbolés AG, Fassina L, Pelà G, Luciani GB, Miragoli M. In-situ optical assessment of rat epicardial kinematic parameters reveals frequency-dependent mechanic heterogeneity related to gender. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2019; 154:94-101. [PMID: 31126627 DOI: 10.1016/j.pbiomolbio.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gender-related cardiac mechanics following the electrical activity has been investigated from basic to clinical research, but results are still controversial. The aim of this work is to study the gender related cardiac mechanics and to focus on its heart rate dependency. METHODS We employed 12 Sprague Dawley rats (5 males and 7 females) of the same age and, through a novel high resolution artificial vision contactless approach, we evaluated in-situ cardiac kinematic. The hearts were paced on the right atria appendage via cathodal stimuli at rising frequency. RESULTS Kinematic data obtained at rising pacing rates are different between male and female rat hearts: male tended to maintain the same level of cardiac force, energy and contractility, while female responded with an increment of such parameters at increasing heart rate. Female hearts preserved their pattern of contraction and epicardial torsion (vorticity) at rising pacing rates compared to male. Furthermore, we observed a difference in the mechanical restitution: systolic time vs. diastolic time, as an index of cardiac performance, reached higher value in male compared to female hearts. CONCLUSION Our innovative technology was capable to evaluate in-situ rat epicardial kinematic at high stimulation frequency, revealing that male preserved kinematic parameters but varying the pattern of contraction/relaxation. On the contrary, female preserved the pattern of contraction/relaxation increasing kinematic parameters.
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Affiliation(s)
- Francesco Paolo Lo Muzio
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona Via S. Francesco 22, 37129, Verona, Italy; Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy
| | - Giacomo Rozzi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona Via S. Francesco 22, 37129, Verona, Italy; Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy
| | - Stefano Rossi
- Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy
| | | | - Lorenzo Fassina
- Department of Industrial Engineering and Informatics, University of Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona Via S. Francesco 22, 37129, Verona, Italy
| | - Michele Miragoli
- Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy; Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Italy.
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Mahmoodzadeh S, Dworatzek E. The Role of 17β-Estradiol and Estrogen Receptors in Regulation of Ca 2+ Channels and Mitochondrial Function in Cardiomyocytes. Front Endocrinol (Lausanne) 2019; 10:310. [PMID: 31156557 PMCID: PMC6529529 DOI: 10.3389/fendo.2019.00310] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
Numerous epidemiological, clinical, and animal studies showed that cardiac function and manifestation of cardiovascular diseases (CVDs) are different between males and females. The underlying reasons for these sex differences are definitely multifactorial, but major evidence points to a causal role of the sex steroid hormone 17β-estradiol (E2) and its receptors (ER) in the physiology and pathophysiology of the heart. Interestingly, it has been shown that cardiac calcium (Ca2+) ion channels and mitochondrial function are regulated in a sex-specific manner. Accurate mitochondrial function and Ca2+ signaling are of utmost importance for adequate heart function and crucial to maintaining the cardiovascular health. Due to the highly sensitive nature of these processes in the heart, this review article highlights the current knowledge regarding sex dimorphisms in the heart implicating the importance of E2 and ERs in the regulation of cardiac mitochondrial function and Ca2+ ion channels, thus the contractility. In particular, we provide an overview of in-vitro and in-vivo studies using either E2 deficiency; ER deficiency or selective ER activation, which suggest that E2 and ERs are strongly involved in these processes. In this context, this review also discusses the divergent E2-responses resulting from the activation of different ER subtypes in these processes. Detailed understanding of the E2 and ER-mediated molecular and cellular mechanisms in the heart under physiological and pathological conditions may help to design more specifically targeted drugs for the management of CVDs in men and women.
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Affiliation(s)
- Shokoufeh Mahmoodzadeh
- Department of Molecular Muscle Physiology, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- *Correspondence: Shokoufeh Mahmoodzadeh
| | - Elke Dworatzek
- Department of Molecular Muscle Physiology, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Institute of Gender in Medicine, Charité Universitaetsmedizin, Berlin, Germany
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11
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The Pythagorean theorem reveals the inherent companion of cardiac ejection fraction. Int J Cardiol 2018; 270:237-243. [DOI: 10.1016/j.ijcard.2018.06.074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/05/2018] [Accepted: 06/18/2018] [Indexed: 11/23/2022]
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12
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Rodgers JL, Rodgers LE, Tian Z, Allen‐Gipson D, Panguluri SK. Sex differences in murine cardiac pathophysiology with hyperoxia exposure. J Cell Physiol 2018; 234:1491-1501. [DOI: 10.1002/jcp.27010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Jennifer L. Rodgers
- Department of Pharmaceutical Sciences College of Pharmacy, University of South Florida Tampa Florida
| | - Lydia E. Rodgers
- Department of Pharmaceutical Sciences College of Pharmacy, University of South Florida Tampa Florida
| | - Zhi Tian
- Department of Pharmaceutical Sciences College of Pharmacy, University of South Florida Tampa Florida
| | - Diane Allen‐Gipson
- Department of Pharmaceutical Sciences College of Pharmacy, University of South Florida Tampa Florida
- Division of Allergy and Immunology, Department of Internal Medicine College of Medicine, University of South Florida Tampa Florida
| | - Siva K. Panguluri
- Department of Pharmaceutical Sciences College of Pharmacy, University of South Florida Tampa Florida
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13
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Sex- and Age-Related Reference Values in Cardiology, with Annotations and Guidelines for Interpretation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:677-706. [PMID: 30051414 DOI: 10.1007/978-3-319-77932-4_41] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The definition of "abnormal" in clinical sciences is often based on so-called reference values which point to a range that experts by some sort of consensus consider as normal when looking at biological variables. Such a level is commonly calculated by taking (twice) the standard deviation from the mean, or considering certain percentiles. The suspicion or even confirmation of a disease is then established by demonstrating that the value measured exceeds the upper or lower reference value. As is often the case, the measurement accuracy may depend on the conditions and specific method employed to collect and analyze data. This implies that, for example, data assessed by 2D echocardiography possibly differ from those obtained by MRI and therefore require modality-specific reference values. In this review we summarize reference values for the electrocardiogram, cardiac compartmental volumes, and arterial vessel size in males and females for various age groups. These values may further depend on other variables such as body size, physical training status, and ethnicity. Additional variables relevant for cardiology such as those referring to the microcirculation and biomarkers are only mentioned with reference to the pertinent literature. In general, the sex- and age-specific differences observed are often remarkable and warrant consideration in clinical practice and basic biomedical sciences.
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14
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Previato M, Osto E, Kerkhof PLM, Parry G, Tona F. Heart Transplantation Survival and Sex-Related Differences. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:379-388. [PMID: 30051397 DOI: 10.1007/978-3-319-77932-4_24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Orthotopic heart transplantation (OHT) is the "gold standard" treatment for patients with end-stage heart failure, with approximately 5000 transplants performed each year worldwide. Heart transplantation survival rates have progressively improved at all time points, despite an increase in donor and recipient age and comorbidity and greater recipient urgency; according to the registry of the International Society of Heart and Lung Transplantation (ISHLT), the median survival of patients posttransplantation is currently 12.2 years.Long-term survival is sub-optimal, and outcomes after OHT remain constrained by the development of acute rejection and cardiac allograft vasculopathy (CAV). Moreover, donor organs are in short supply, making optimal organ utilization an ongoing priority. For these reasons, substantial interest continues to exist in identifying factors portending increased survival and improved organ utilization.
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Affiliation(s)
- Martina Previato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Elena Osto
- Laboratory of Translational Nutrition Biology, Federal Institute of Technology Zurich ETHZ, Zurich, Switzerland. .,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland. .,University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland.
| | - Peter L M Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Gareth Parry
- Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Francesco Tona
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
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15
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Kerkhof PLM, Osto E. Women and Men in the History of Western Cardiology: Some Notes on Their Position as Patients, Role as Investigational Study Subjects, and Impact as Professionals. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:1-30. [PMID: 30051374 DOI: 10.1007/978-3-319-77932-4_1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Nowadays, it is generally appreciated that studies in the medical field should not only include sex-related aspects but also consider age. In the past, taking the era of Hippocrates as a starting point for the Western medical sciences, such aspects were less urgent and barely relevant. However, considering such details during daily life became increasingly important as the traditional roles of men and women in society and household converged. In the Western world, this fundamental transition process started recently and is advancing at an accelerated pace. Research about the role of women has also evolved, starting from plain history about the lives of women to a description of the relation between men and women, resulting in the gender concept. The present survey highlights a historical selection of observations referring to the impact of men and women on the medical sciences, as patient, study object, and professional. Whenever relevant, focus will be on the field of cardiovascular investigations as documented in the Western world. Rather than being exhaustive, we focus on a few remarkable icons, including Trota of Salerno, Hildegard von Bingen, and Miguel Serveto.
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Affiliation(s)
- Peter L M Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands.
| | - Elena Osto
- Laboratory of Translational Nutrition Biology, Federal Institute of Technology Zurich ETHZ, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
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Kerkhof PLM, Kuznetsova T, Yasha Kresh J, Handly N. Cardiophysiology Illustrated by Comparing Ventricular Volumes in Healthy Adult Males and Females. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:123-138. [PMID: 30051381 DOI: 10.1007/978-3-319-77932-4_8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
Abstract
Recent advances in cardiac imaging techniques have substantially contributed to a growing interest in the analysis of global cardiac chamber dimensions and regional myocardial deformation. During the cardiac cycle, ventricular luminal volume varies due to the contraction process, which also confers a shape change including substantial alteration of long axis length, as well as rotation of the base compared to the apex. Local deformation can be assessed by strain (rate) analysis. Reviewing the present literature, it must be concluded that there is no single metric available to comprehensively characterize ventricular function. Every candidate advanced thus far has been found to incompletely reflect ventricular performance. This observation is not surprising in view of the complexity of the cardiac pump system. Additionally, sex-specific modifiers may play a role. More than three decades ago, it was shown that on average the ventricular volume is smaller in healthy women compared to matched males. Therefore, the present contribution concerns the interpretation of data derived from the healthy heart in both men and women. Starting from the classical Starling concept, we apply a simple mathematical transformation which permits an insightful representation of ventricular mechanics. Relating end-systolic volume (ESV) to end-diastolic volume creates the ventricular volume regulation graph which features the pertinent working point of an individual heart. This fundamental approach illustrates why certain proposed performance indexes cannot individually reveal the essence of ventricular systolic function. We demonstrate that particular metrics are highly interconnected and just tell us the same story in a different disguise. It is imperative to understand which associations exist and if they expectedly are (nearly) linear or frankly nonlinear. Notably, ejection fraction (EF) is primarily determined by ESV, while in turn EF is not much different from ventriculo-arterial coupling (VAC). Insight into cardiac function is promoted by identification of the paramount/essential components involved. The smaller ESV (p < 0.0001) implies that EF is higher in women and may also have consequences for VAC.
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Affiliation(s)
- Peter L M Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands.
| | - Tatiana Kuznetsova
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - J Yasha Kresh
- Departments of Cardiothoracic Surgery and Medicine (Cardiology), Drexel University College of Medicine, IME, University of Pennsylvania, Philadelphia, PA, USA
| | - Neal Handly
- Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
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Heart Function Analysis in Cardiac Patients with Focus on Sex-Specific Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:361-377. [DOI: 10.1007/978-3-319-77932-4_23] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Feridooni HA, MacDonald JK, Ghimire A, Pyle WG, Howlett SE. Acute exposure to progesterone attenuates cardiac contraction by modifying myofilament calcium sensitivity in the female mouse heart. Am J Physiol Heart Circ Physiol 2016; 312:H46-H59. [PMID: 27793852 DOI: 10.1152/ajpheart.00073.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 11/22/2022]
Abstract
Acute application of progesterone attenuates cardiac contraction, although the underlying mechanisms are unclear. We investigated whether progesterone modified contraction in isolated ventricular myocytes and identified the Ca2+ handling mechanisms involved in female C57BL/6 mice (6-9 mo; sodium pentobarbital anesthesia). Cells were field-stimulated (4 Hz; 37°C) and exposed to progesterone (0.001-10.0 μM) or vehicle (35 min). Ca2+ transients (fura-2) and cell shortening were recorded simultaneously. Maximal concentrations of progesterone inhibited peak contraction by 71.4% (IC50 = 160 ± 50 nM; n = 12) and slowed relaxation by 75.4%. By contrast, progesterone had no effect on amplitudes or time courses of underlying Ca2+ transients. Progesterone (1 µM) also abbreviated action potential duration. When the duration of depolarization was controlled by voltage-clamp, progesterone attenuated contraction and slowed relaxation but did not affect Ca2+ currents, Ca2+ transients, sarcoplasmic reticulum (SR) content, or fractional release of SR Ca2+ Actomyosin MgATPase activity was assayed in myofilaments from hearts perfused with progesterone (1 μM) or vehicle (35 min). While maximal responses to Ca2+ were not affected by progesterone, myofilament Ca2+ sensitivity was reduced (EC50 = 0.94 ± 0.01 µM for control, n = 7 vs. 1.13 ± 0.05 μM for progesterone, n = 6; P < 0.05) and progesterone increased phosphorylation of myosin binding protein C. The effects on contraction were inhibited by lonaprisan (progesterone receptor antagonist) and levosimendan (Ca2+ sensitizer). Unlike results in females, progesterone had no effect on contraction or myofilament Ca2+ sensitivity in age-matched male mice. These data indicate that progesterone reduces myofilament Ca2+ sensitivity in female hearts, which may exacerbate manifestations of cardiovascular disease late in pregnancy when progesterone levels are high. NEW & NOTEWORTHY We investigated myocardial effects of acute application of progesterone. In females, but not males, progesterone attenuates and slows cardiomyocyte contraction with no effect on calcium transients. Progesterone also reduces myofilament calcium sensitivity in female hearts. This may adversely affect heart function, especially when serum progesterone levels are high in pregnancy.Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/acute-progesterone-modifies-cardiac-contraction/.
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Affiliation(s)
- Hirad A Feridooni
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Anjali Ghimire
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - W Glen Pyle
- Centre for Cardiovascular Investigations, Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada; and
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada; .,Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada
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Paonessa JR, Brennan T, Pimentel M, Steinhaus D, Feng M, Celi LA. Hyperdynamic left ventricular ejection fraction in the intensive care unit. Crit Care 2015; 19:288. [PMID: 26250903 PMCID: PMC4528812 DOI: 10.1186/s13054-015-1012-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/12/2015] [Indexed: 12/02/2022] Open
Abstract
Introduction Limited information exists on the etiology, prevalence, and significance of hyperdynamic left ventricular ejection fraction (HDLVEF) in the intensive care unit (ICU). Our aim in the present study was to compare characteristics and outcomes of patients with HDLVEF with those of patients with normal left ventricular ejection fraction in the ICU using a large, public, deidentified critical care database. Methods We conducted a longitudinal, single-center, retrospective cohort study of adult patients who underwent echocardiography during a medical or surgical ICU admission at the Beth Israel Deaconess Medical Center using the Multiparameter Intelligent Monitoring in Intensive Care II database. The final cohort had 2867 patients, of whom 324 had HDLVEF, defined as an ejection fraction >70 %. Patients with an ejection fraction <55 % were excluded. Results Compared with critically ill patients with normal left ventricular ejection fraction, the finding of HDLVEF in critically ill patients was associated with female sex, increased age, and the diagnoses of hypertension and cancer. Patients with HDLVEF had increased 28-day mortality compared with those with normal ejection fraction in multivariate logistic regression analysis adjusted for age, sex, Sequential Organ Failure Assessment score, Elixhauser score for comorbidities, vasopressor use, and mechanical ventilation use (odds ratio 1.38, 95 % confidence interval 1.039–1.842, p =0.02). Conclusions The presence of HDLVEF portended increased 28-day mortality, and may be helpful as a gravity marker for prognosis in patients admitted to the ICU. Further research is warranted to gain a better understanding of how these patients respond to common interventions in the ICU and to determine if pharmacologic modulation of HDLVEF improves outcomes.
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Affiliation(s)
- Joseph R Paonessa
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,, Present address: 1122 N. Clark Street, Apt. 3709, Chicago, IL, 60610, USA.
| | - Thomas Brennan
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA, 02139, USA.
| | - Marco Pimentel
- Institute of Biomedical Engineering, Oxford University, Headington, Oxford, OX3 7DQ, UK.
| | - Daniel Steinhaus
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Mengling Feng
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA, 02139, USA.
| | - Leo Anthony Celi
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA, 02139, USA.
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20
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Ayaz O, Howlett SE. Testosterone modulates cardiac contraction and calcium homeostasis: cellular and molecular mechanisms. Biol Sex Differ 2015; 6:9. [PMID: 25922656 PMCID: PMC4411792 DOI: 10.1186/s13293-015-0027-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/27/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence of cardiovascular disease rises dramatically with age in both men and women. Because a woman's risk of cardiovascular disease rises markedly after the onset of menopause, there has been growing interest in the effect of estrogen on the heart and its role in the pathophysiology of these diseases. Much less attention has been paid to the impact of testosterone on the heart, even though the levels of testosterone also decline with age and low-testosterone levels are linked to the development of cardiovascular diseases. The knowledge that receptors for all major sex steroid hormones, including testosterone, are present on individual cardiomyocytes suggests that these hormones may influence the heart at the cellular level. Indeed, it is well established that there are male-female differences in intracellular Ca(2+) release and contraction in isolated ventricular myocytes. Growing evidence suggests that these differences arise from effects of sex steroid hormones on processes involved in intracellular Ca(2+) homeostasis. This review considers how myocardial contractile function is modified by testosterone, with a focus on the impact of testosterone on processes that regulate Ca(2+) handling at the level of the ventricular myocyte. The idea that testosterone regulates Ca(2+) handling in the heart is important, as Ca(2+) dysregulation plays a key role in the pathogenesis of a variety of different cardiovascular diseases. A better understanding of sex hormone regulation of myocardial Ca(2+) homeostasis may reveal new targets for the treatment of cardiovascular diseases in all older adults.
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Affiliation(s)
- Omar Ayaz
- Department of Pharmacology, Dalhousie University, 5850 College Street, Sir Charles Tupper Medical Building, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Susan Ellen Howlett
- Department of Pharmacology, Dalhousie University, 5850 College Street, Sir Charles Tupper Medical Building, PO Box 15000, Halifax, NS B3H 4R2 Canada
- Medicine (Geriatric Medicine), Dalhousie University, 5850 College Street, PO Box 15000, Halifax, NS B3H 4R2 Canada
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21
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Sex differences in SR Ca(2+) release in murine ventricular myocytes are regulated by the cAMP/PKA pathway. J Mol Cell Cardiol 2014; 75:162-73. [PMID: 25066697 DOI: 10.1016/j.yjmcc.2014.07.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/26/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
Abstract
Previous studies have shown that ventricular myocytes from female rats have smaller contractions and Ca(2+) transients than males. As cardiac contraction is regulated by the cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) pathway, we hypothesized that sex differences in cAMP contribute to differences in Ca(2+) handling. Ca(2+) transients (fura-2) and ionic currents were measured simultaneously (37°C, 2Hz) in ventricular myocytes from adult male and female C57BL/6 mice. Under basal conditions, diastolic Ca(2+), sarcoplasmic reticulum (SR) Ca(2+) stores, and L-type Ca(2+) current did not differ between the sexes. However, female myocytes had smaller Ca(2+) transients (26% smaller), Ca(2+) sparks (6% smaller), and excitation-contraction coupling gain in comparison to males (23% smaller). Interestingly, basal levels of intracellular cAMP were lower in female myocytes (0.7±0.1 vs. 1.7±0.2fmol/μg protein; p<0.001). Importantly, PKA inhibition (2μM H-89) eliminated male-female differences in Ca(2+) transients and gain, as well as Ca(2+) spark amplitude. Western blots showed that PKA inhibition also reduced the ratio of phospho:total RyR2 in male hearts, but not in female hearts. Stimulation of cAMP production with 10μM forskolin abolished sex differences in cAMP levels, as well as differences in Ca(2+) transients, sparks, and gain. To determine if the breakdown of cAMP differed between the sexes, phosphodiesterase (PDE) mRNA levels were measured. PDE3 expression was similar in males and females, but PDE4B expression was higher in female ventricles. The inhibition of cAMP breakdown by PDE4 (10μM rolipram) abolished differences in Ca(2+) transients and gain. These findings suggest that female myocytes have lower levels of basal cAMP due, in part, to higher expression of PDE4B. Lower cAMP levels in females may attenuate PKA phosphorylation of Ca(2+) handling proteins in females, and may limit positive inotropic responses to stimulation of the cAMP/PKA pathway in female hearts.
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Whaley-Connell AT, Habibi J, Aroor A, Ma L, Hayden MR, Ferrario CM, Demarco VG, Sowers JR. Salt loading exacerbates diastolic dysfunction and cardiac remodeling in young female Ren2 rats. Metabolism 2013; 62:1761-71. [PMID: 24075738 PMCID: PMC3833978 DOI: 10.1016/j.metabol.2013.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Recent data would suggest pre-menopausal insulin resistant women are more prone to diastolic dysfunction than men, yet it is unclear why. We and others have reported that transgenic (mRen2)27 (Ren2) rats overexpressing the murine renin transgene are insulin resistant due to oxidative stress in insulin sensitive tissues. As increased salt intake promotes inflammation and oxidative stress, we hypothesized that excess dietary salt would promote diastolic dysfunction in transgenic females under conditions of excess tissue Ang II and circulating aldosterone levels. MATERIALS/METHODS For this purpose we evaluated cardiac function in young female Ren2 rats or age-matched Sprague-Dawley (SD) littermates exposed to a high (4%) salt or normal rat chow intake for three weeks. RESULTS Compared to SD littermates, at 10weeks of age, female Ren2 rats fed normal chow showed elevations in left ventricular (LV) systolic pressures, LV and cardiomyocyte hypertrophy, and displayed reductions in LV initial filling rate accompanied by increases in 3-nitrotyrosine content as a marker of oxidant stress. Following 3weeks of a salt diet, female Ren2 rats exhibited no further changes in LV systolic pressure, insulin resistance, or markers of hypertrophy but exaggerated increases in type 1 collagen, 3-nitrotryosine content, and diastolic dysfunction. These findings occurred in parallel with ultrastructural findings of pericapillary fibrosis, increased LV remodeling, and mitochondrial biogenesis. CONCLUSION These data suggest that a diet high in salt in hypertensive female Ren2 rats promotes greater oxidative stress, maladaptive LV remodeling, fibrosis, and associated diastolic dysfunction without further changes in LV systolic pressure or hypertrophy.
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MESH Headings
- Animals
- Collagen/metabolism
- Female
- Fibrosis/pathology
- Fluorescent Antibody Technique
- Heart Failure, Diastolic/chemically induced
- Heart Failure, Diastolic/pathology
- Hemodynamics/drug effects
- Hemodynamics/physiology
- Hypertrophy, Left Ventricular/chemically induced
- Hypertrophy, Left Ventricular/pathology
- Magnetic Resonance Imaging
- Microscopy, Electron, Transmission
- Mitochondria, Heart/drug effects
- Mitochondria, Heart/physiology
- Myocardium/metabolism
- Myocardium/pathology
- Oxidative Stress/physiology
- Rats
- Rats, Sprague-Dawley
- Rats, Transgenic
- Sodium, Dietary/pharmacology
- Tyrosine/analogs & derivatives
- Tyrosine/metabolism
- Ventricular Function, Left/physiology
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Affiliation(s)
- Adam T Whaley-Connell
- Research Service Harry S Truman Memorial Veterans Hospital, Research Service, 800 Hospital Dr, Columbia, MO 65212, USA; University of Missouri School of Medicine, Departments of Internal Medicine, Divisions of Nephrology and Hypertension, Columbia, MO, USA; University of Missouri School of Medicine, Departments of Internal Medicine, Division of Endocrinology and Metabolism, Columbia, MO, USA; University of Missouri School of Medicine, Diabetes and Cardiovascular Center, Columbia, MO, USA.
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Sex differences in mechanisms of cardiac excitation-contraction coupling. Pflugers Arch 2013; 465:747-63. [PMID: 23417603 PMCID: PMC3651827 DOI: 10.1007/s00424-013-1233-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/29/2013] [Accepted: 01/30/2013] [Indexed: 11/25/2022]
Abstract
The incidence and expression of cardiovascular diseases differs between the sexes. This is not surprising, as cardiac physiology differs between men and women. Clinical and basic science investigations have shown important sex differences in cardiac structure and function. The pervasiveness of sex differences suggests that such differences must be fundamental, likely operating at a cellular level. Indeed, studies have shown that isolated ventricular myocytes from female animals have smaller and slower contractions and underlying calcium transients compared to males. Recent evidence suggests that this arises from sex differences in components of the cardiac excitation–contraction coupling pathway, the sequence of events linking myocyte depolarization to calcium release from the sarcoplasmic reticulum and subsequent contraction. The concept that sex hormones may regulate intracellular calcium at the level of the cardiomyocyte is important, as levels of these hormones decline in both men and women as the incidence of cardiovascular disease rises. This review focuses on the impact of sex on cardiac contraction, in particular at the cellular level, and highlights specific components of the excitation–contraction coupling pathway that differ between the sexes. Understanding sex hormone regulation of calcium homeostasis in the heart may reveal new avenues for therapeutic strategies to treat cardiac dysfunction and cardiovascular diseases.
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Hlebowicz J, Lindstedt S, Björgell O, Dencker M. The effect of endogenously released glucose, insulin, glucagon-like peptide 1, ghrelin on cardiac output, heart rate, stroke volume, and blood pressure. Cardiovasc Ultrasound 2011; 9:43. [PMID: 22206473 PMCID: PMC3280936 DOI: 10.1186/1476-7120-9-43] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 12/29/2011] [Indexed: 11/24/2022] Open
Abstract
Background Ingestion of a meal increases the blood flow to the gastrointestinal organs and affects the heart rate (HR), blood pressure and cardiac output (CO), although the mechanisms are not known. The aim of this study was to evaluate the effect of endogenously released glucose, insulin, glucagon-like peptide 1 (GLP-1), ghrelin on CO, HR, stroke volume (SV), and blood pressure. Methods Eleven healthy men and twelve healthy women ((mean ± SEM) aged: 26 ± 0.2 y; body mass index: 21.8 ± 0.1 kg/m2)) were included in this study. The CO, HR, SV, systolic and diastolic blood pressure, antral area, gastric emptying rate, and glucose, insulin, GLP-1 and ghrelin levels were measured. Results The CO and SV at 30 min were significantly higher, and the diastolic blood pressure was significantly lower, than the fasting in both men and women (P < 0.05). In men, significant correlations were found between GLP-1 level at 30 min and SV at 30 min (P = 0.015, r = 0.946), and between ghrelin levels and HR (P = 0.013, r = 0.951) at 110 min. Significant correlations were also found between the change in glucose level at 30 min and the change in systolic blood pressure (P = 0.021, r = -0.681), and the change in SV (P = 0.008, r = -0.748) relative to the fasting in men. The insulin 0-30 min AUC was significantly correlated to the CO 0-30 min AUC (P = 0.002, r = 0.814) in men. Significant correlations were also found between the 0-120 min ghrelin and HR AUCs (P = 0.007, r = 0.966) in men. No statistically significant correlations were seen in women. Conclusions Physiological changes in the levels of glucose, insulin, GLP-1 and ghrelin may influence the activity of the heart and the blood pressure. There may also be gender-related differences in the haemodynamic responses to postprandial changes in hormone levels. The results of this study show that subjects should not eat immediately prior to, or during, the evaluation of cardiovascular interventions as postprandial affects may affect the results, leading to erroneous interpretation of the cardiovascular effects of the primary intervention. Trial registration number NCT01027507
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Affiliation(s)
- Joanna Hlebowicz
- Center for Emergency, Department of Cardiology, Skåne University Hospital, Malmö, Lund University, Sweden.
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Sex-specific normal limits of left ventricular ejection fraction and volumes estimated by gated myocardial perfusion imaging in adult patients in Taiwan: a comparison between two quantitative methods. Nucl Med Commun 2011; 32:113-20. [PMID: 21150486 DOI: 10.1097/mnm.0b013e3283422838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The left ventricular (LV) ejection fraction (EF) and end-diastolic and end-systolic volumes are strong predictors for prognosis of cardiac death. Quantitative-gated myocardial perfusion single-photon emission computed tomography (SPECT) is widely used to measure LV functional parameters. However, systematic differences may exist between referred populations. We sought to derive sex-specific normal values for LV functional parameters obtained using two quantitative methods. METHODS Among 1044 consecutive patients who underwent dipyridamole stress myocardial perfusion-gated 201Tl SPECT in 2008, a total of 140 (56 men) with normal perfusion imaging were selected. None had cardiac diseases or experienced cardiac events during 1-year follow-up. LV EF and end-diastolic and end-systolic volumes were calculated by quantitative-gated SPECT (QGS) and four-dimensional-myocardial single photon emission computed tomography (4D-MSPECT), respectively. RESULTS There was excellent intrareader and interreader reproducibility for both QGS and 4D-MSPECT algorithms. The differences in LV volumes and EF between the software packages were small. High prevalence of small heart was noted in the study population, especially in women (>60%). Volumetric measures were significantly greater (P<0.001) in men than in women, even after adjustment for body surface area. Women had a higher LV EF than men when using QGS methods, but not when using the 4D-MSPECT method. Compared with 4D-MSPECT, sex remained significantly associated with EF determined by QGS methods, independent of age and body weight. CONCLUSION LV functional parameters determined by means of gated 201Tl SPECT need to be corrected for sex and algorithms. Separate reference values of LV EF and volumes need to be applied in both women and men depending on the software package used.
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Farrell SR, Ross JL, Howlett SE. Sex differences in mechanisms of cardiac excitation-contraction coupling in rat ventricular myocytes. Am J Physiol Heart Circ Physiol 2010; 299:H36-45. [DOI: 10.1152/ajpheart.00299.2010] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Components of excitation-contraction (E-C) coupling were compared in ventricular myocytes isolated from 3-mo-old male and female rats. Ca2+ concentrations (fura-2) and cell shortening (edge detector) were measured simultaneously (37°C). Membrane potential and ionic currents were measured with microelectrodes. Action potentials were similar in male and female myocytes, but contractions were smaller and slower in females. In voltage-clamped cells, peak contractions were smaller in females than in males (5.1 ± 0.7% vs. 7.7 ± 0.8% diastolic length, P < 0.05). Similarly, Ca2+ transients were smaller in females than in males and the rate of rise of the Ca2+ transient was slower in females. Despite smaller contractions and Ca2+ transients in females, Ca2+ current density was similar in both groups. Sarcoplasmic reticulum Ca2+ content, assessed with caffeine, did not differ between the sexes. However, E-C coupling gain (rate of Ca2+ release/Ca2+ current) was smaller in females than in males (157.0 ± 15.6 vs. 338.4 ± 54.3 (nM/s)/(pA/pF), P < 0.05). To determine whether the reduced gain in female cells was due to changes in unitary Ca2+ release, spontaneous Ca2+ sparks were evaluated (fluo-4, 37°C). Spark frequencies and widths were similar in both groups, but spark amplitudes were smaller in females than in males (0.56 ± 0.01 vs. 0.64 ± 0.01 ΔF/F0, P < 0.05). Spark durations also were shorter in females than in males (full duration at half-maximum = 14.86 ± 0.17 vs. 16.25 ± 0.27 ms, P < 0.05). These observations suggest that decreases in the size and duration of Ca2+ sparks contributes to the decrease in E-C coupling gain in female myocytes. Thus, differences in cardiac contractile function arise, in part, from differences in unitary Ca2+ release between the sexes.
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Affiliation(s)
| | | | - Susan E. Howlett
- Departments of 1Pharmacology and
- Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada
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Mitoff PR, Al-Hesayen A, Azevedo E, Newton GE, Mak S. Sex differences in basal hemodynamics and left ventricular function in humans with and without heart failure. Am Heart J 2007; 154:575-80. [PMID: 17719309 DOI: 10.1016/j.ahj.2007.04.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 04/25/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women with systolic heart failure (HF) demonstrate better survival than men. Whether sex differences occur in hemodynamics or measures of left ventricular (LV) function is not well understood. METHODS We retrospectively analyzed a cohort who underwent evaluation by right heart catheterization +/- micromanometer-tipped catheterization of the LV. Two groups, defined at the time of catheterization, were studied: normal LV (NLV) function or HF (LV ejection fraction <35%, New York Heart Association II-III symptoms). For each female, we identified 2 male controls matched for age and LV ejection fraction in the HF group. RESULTS In the NLV group, we matched 73 men (56 +/- 10 years) to 39 women (56 +/- 10 years). In the HF group, we matched 71 men (57 +/- 10 years) to 36 women (57 +/- 10 years). In the NLV group, women had higher heart rate and lower right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure. Left ventricular peak systolic pressure was higher, and LV end-diastolic pressure was lower in women. In the HF group, no sex differences were observed in any hemodynamic measurement. In both groups, no sex differences were observed in isovolumic contractility or relaxation. CONCLUSIONS Sex differences in hemodynamics are observed in patients with NLV function but not with HF. The intrinsic or extrinsic factors responsible for sex differences observed in patients with NLV function may be eclipsed by the HF disease state or its treatment.
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Affiliation(s)
- Peter R Mitoff
- Clinical Cardiovascular Science Research Laboratory, Mount Sinai Hospital, Toronto, Ontario, Canada
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Chung AK, Das SR, Leonard D, Peshock RM, Kazi F, Abdullah SM, Canham RM, Levine BD, Drazner MH. Women Have Higher Left Ventricular Ejection Fractions Than Men Independent of Differences in Left Ventricular Volume. Circulation 2006; 113:1597-604. [PMID: 16567580 DOI: 10.1161/circulationaha.105.574400] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Although gender-specific criteria are common for defining cardiac traits such as left ventricular hypertrophy, left ventricular ejection fraction (LVEF) thresholds widely used in clinical practice have traditionally been the same for women and men, perhaps because it remains uncertain whether there is a systematic difference in LVEF between genders.
Methods and Results—
Using cardiac magnetic resonance imaging in a probability-based sample of Dallas County residents aged 30 to 65 years (1435 women and 1183 men), we compared LVEF in women and men. The association of gender with stroke volume independent of end-diastolic volume (EDV) or other potential confounders was assessed by multivariable analysis. Gender-specific thresholds for a low LVEF were defined at the 2.5th percentile in women and men from a healthy reference subpopulation. The median (25th, 75th percentile) LVEF was higher in women than in men (75% [70%, 79%] in women versus 70% [65%, 75%] in men,
P
<0.001). Left ventricular EDV and end-systolic volume indexed to body surface area were smaller in women than in men (
P
<0.001 for both). Gender remained significantly associated with stroke volume, independent of EDV and other potential confounders in multivariable analysis. A low LVEF was defined as below 61% in women and below 55% in men.
Conclusions—
Women have a higher LVEF than men in the general population, secondary to a higher stroke volume for a given EDV independent of known potential confounders.
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Affiliation(s)
- Anne K Chung
- Donald W. Reynolds Cardiovascular Clinical Research Center, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA
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Spencer AP, Wingate S. Cardiovascular drug therapy in women. J Cardiovasc Nurs 2006; 20:408-17; quiz 418-9. [PMID: 16485625 DOI: 10.1097/00005082-200511000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular disease has been the leading cause of morbidity and mortality in American women; yet, until recently, there was no mandate to specifically include women in clinical trials of the major cardiovascular drugs. Despite new regulations, there is still a lack of readily available data for the clinician to use when planning drug therapy for women, as many of the drugs in use today were developed and tested prior to the new regulations being in effect. The purpose of this article is to provide advanced practice nurses with the most current information on the use of cardiovascular drugs in women. Information on the unique biological features of women is first presented to provide background material for subsequent sections. This is followed by an explanation of pharmacokinetic processes in women to include information on absorption, distribution, and clearance of drugs. A brief review of the effects of the phases of the menstrual cycle on drug therapy is given and then issues related to the profound physiologic changes in pregnancy and subsequent effects on drug therapy are reviewed. An analysis of the strength of the available evidence on drug therapies in women from the major trials on acute coronary syndromes, heart failure, dyslipidemia, atrial fibrillation, and hypertension is provided. Finally, implications for practice, including recommendations for drug prescription, are summarized.
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Affiliation(s)
- Anne P Spencer
- Medical University of South Carolina, Charleston, SC, USA
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Petersen SE, Hudsmith LE, Robson MD, Doll HA, Francis JM, Wiesmann F, Jung BA, Hennig J, Watkins H, Neubauer S. Sex-specific characteristics of cardiac function, geometry, and mass in young adult elite athletes. J Magn Reson Imaging 2006; 24:297-303. [PMID: 16823779 DOI: 10.1002/jmri.20633] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To study young adult elite athletes with age- and sex-matched sedentary controls to assess sex-specific differences for left ventricular (LV) and right ventricular (RV) volumes and mass as well as for LV contraction and relaxation. MATERIALS AND METHODS A total of 23 male athletes (mean age 25 +/- 4 years, training 22 +/- 7 hours/week in rowing, swimming, or triathlon) and 20 female athletes (mean age 24 +/- 4 years, training 19 +/- 5 hours/week in rowing, swimming, or triathlon) and age- and sex-matched sedentary controls (21 male/17 female) underwent cardiovascular magnetic resonance (CMR) imaging (1.5 Tesla). Cardiac phase contrast imaging using a black-blood k-space segmented gradient echo sequence was used for analysis of cardiac contraction and relaxation and steady-state free-precession cine images were acquired for determination of cardiac volumes and mass. RESULTS Male and female athletes showed similar increases in LV and RV volume and mass indices when compared to controls (ranging between 15% and 42%). No sex-specific differences in training effect on LV and RV volumes, mass indices, and ejection fractions, as well as LV to RV ratios of these volume and mass indices (parameters of balanced LV and RV dilatation and hypertrophy) were observed (all P for interaction >0.05). Similarly, no sex-specific differences in training effect on cardiac contraction and relaxation were found (all P for interaction >0.05). CONCLUSION Young adult elite athletes do not show sex-specific adaptive structural and functional changes to exercise training in accordance with the benign nature of the hypertrophy associated with athlete's heart.
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Affiliation(s)
- Steffen E Petersen
- University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Abstract
Almost half of the patients affected with congestive heart failure (CHF) in the United States are women. However, past studies have included predominantly men and generalized results to women. Many women with CHF are older, have hypertension, and have higher ejection fractions. Survival differences have been reported previously with conflicting results. Although treatment for left ventricular dysfunction is somewhat standardized, treatment for diastolic dysfunction is less defined. Clinical trials for this group of patients, many of whom are women, have not been performed. In comparison with men, women have several cardiovascular differences as well as differences in electrical properties. In addition, response to medical (pharmacologic) therapy may differ in men and women.Finally, functional status has been shown to be compromised in both men and women with CHF; however, some studies have shown women to experience more exercise intolerance. This may be because more women than men have diastolic dysfunction. Few women have been included in exercise trials. Future trials must address women with CHF, many of whom are older and have normal (or near normal) left ventricular function or diastolic dysfunction.
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Affiliation(s)
- C L Murdaugh
- College of Nursing, University of Arizona, Tucson
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Tofler GH, Stone PH, Muller JE, Willich SN, Davis VG, Poole WK, Strauss HW, Willerson JT, Jaffe AS, Robertson T. Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women. J Am Coll Cardiol 1987; 9:473-82. [PMID: 3819194 DOI: 10.1016/s0735-1097(87)80038-4] [Citation(s) in RCA: 324] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Controversy has arisen concerning whether gender influences the prognosis after myocardial infarction. Although some studies have shown there to be no difference between the sexes, most have indicated a worse prognosis for women, attributing this to differences in baseline characteristics. It has been further suggested that black women have a particularly poor prognosis after infarction. To determine the contribution of gender and race to the course of infarction, 816 patients with confirmed myocardial infarction who were enrolled in the Multicenter Investigation of the Limitation of Infarct Size (MILIS) were analyzed. Of those patients, 226 were women and 590 were men, 142 were black and 674 were white. The cumulative mortality rate at 48 months was 36% for women versus 21% for men (p less than 0.001, mean follow-up 32 months). The cumulative mortality rate by race was 34% for blacks versus 24% for whites (p less than 0.005). Both women and blacks exhibited more baseline characteristics predictive of mortality than did their male or white counterparts. It was possible to account for the greater mortality rate of blacks by identifiable baseline variables; however, even after adjustment, the mortality rate for women remained significantly higher (p less than 0.002). The poorer prognosis for women was influenced by a particularly high mortality rate among black women (48%); the mortality rate for white women was 32%, for black men 23% and for white men 21%. The mortality for black women was significantly greater than that of the other subgroups. Thus, findings in the MILIS population indicate that the prognosis after myocardial infarction is worse for women, particularly black women.
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