{
  "abstract": "Background Heterogeneity in heart failure with preserved ejection fraction (HFpEF) is often cited as a reason for scarcity of effective treatment options. There is increasing evidence for a pathophysiological role of epicardial adipose tissue (EAT) in HFpEF. The differential burden of EAT in men and women, and its relation to cardiac structure and function is not well described.Objective To examine sex-related differences in epicardial adipose tissue (EAT) and cardiac structure and their impact on rest and exercise haemodynamics in individuals with HFpEF.Method Individuals with clinically-confirmed HFpEF were prospectively enrolled. All underwent laboratory tests, rest and submaximal (35W) exercise cardiac magnetic resonance imaging (eCMR), echocardiography, lung ultrasound and a 6-minute walk test (6MWT).Results 70 individuals with clinically-confirmed HFpEF were enrolled (40 men, 57%). There was equal prevalence of hypertension, diabetes and atrial fibrillation, with comparable body mass index (BMI) and serum NTproBNP levels between men and women. At rest, women had smaller cardiac chambers, stroke volume (SV) and cardiac index (CI) but higher rest left ventricular ejection fraction (LVEF) and LV global longitudinal strain (GLS) [LVEF 64 (63–67) vs. 61% (56–65), p=0.005; LV GLS 17 (14–20) vs. 15% (13–17), p=0.04]. Women continued to exhibit lower CI [4.3 (0.9) vs. 5.1 L/min/m 2 (1.3), p=0.006] with features of worse LV reserve (DLVEF), compared to men, at 35W exercise [DLVEF 2.5±4.9) vs. 4.4± 4.5%, p=0.09]. Exercise CI was positively associated with 6MWT distance only in women [std. b 0.41, p=0.009 vs. std. b 0.13, p=0.34; adjusted for age, height and BMI]. In contrast, men demonstrated worse right heart function at rest, greater ventricular interdependence (as indicated by a higher eccentricity index, EI), exercise-induced increase in right atrial volume (%DRAESV; p=0.008) and predisposition to transient pulmonary congestion measured as B-lines on lung ultrasound (exercise B-lines: std. b 0.24, p=0.03). Men had higher volumes of epicardial adipose tissue (EAT) indexed to body surface area [EAT 68 (54–78) vs. 52ml/m2 (41–65), p=0.006]. However, in women, higher EAT volumes were preferentially associated with smaller cardiac volumes, LV systolic reserve and exercise CI (std. b -0.36, p=0.048). Whilst EAT volumes were associated with higher rest EI in both men and women, an association with greater ventricular interdependence during exercise was only apparent in men [std. b 0.41, p=0.008].Conclusion Our findings suggest exercise phenotypes in HFpEF may be distinct between men and women. While women exhibit lower cardiac index and LV systolic reserve, men predominantly manifest worse right heart parameters, pericardial restraint and resultant pulmonary congestion. These differences may relate to differential effects of EAT in men and women. Further research exploring sex-dependent mechanisms in HFpEF may guide targeted therapy.Abstract 6-016 Table 1Baseline demographics Women (n=30) Men (n=40) p Age 77 (73, 79) 77 (73, 79) 0.99 BMI (kg/m2) 31 (27, 36) 33 (29, 37) 0.28 NTproBNP (ng/L) 698 (235, 1804) 902 (532, 1496) 0.56 6MWT distance (m) 364 (288, 407) 390 (325, 450) 0.16 6MWT Borg scale 3 (2,4) 2 (1,3) 0.01 Hypertension 20 (67) 34 (85) 0.07 Diabetes mellitus 4 (13) 12 (30) 0.10 Atrial fibrillation 18 (60) 28 (70) 0.38 Beta-blocker 15 (50) 26 (65) 0.21 Loop diuretics 16 (53) 19 (48) 0.63 BMI: body mass index; NTproBNP: N-terminal probrain natriuretic peptide; 6MWT: 6-minute walk testAbstract 6-016 Table 2Rest imaging parameters in women and men Women (n=30) Men (n=40) p Rest E/e' 11.3 (9.3, 13.5) 11.1 (8.8, 13.0) 0.50 Rest PASP (mmHg) 27 (25, 31) 31 (25, 39) 0.10 Rest LVEDVi (ml/m2) 64 (55, 73) 78 (64, 92) 0.002 Rest LVSVi (ml/m2) 41 (36, 47) 45 (40, 56) 0.02 Rest LVEF (%) 65 (63, 67) 61 (56, 65) 0.005 Rest LV GLS (%) 17 (14, 20) 15 (13, 17) 0.04 Rest RVEDVi (ml/m2) 64 (56, 73) 77 (62, 100) 0.002 Rest RVEF (%) 62 (59, 67) 56 (53, 64) 0.003 Rest RV SV/ESV 1.7 (1.4, 2.1) 1.3 (1.1, 1.8) 0.003 Rest cardiac index, CI (L/min/m2) 2.5 (2.2, 3.0) 3.1 (2.6, 3.6) 0.003 PASP: pulmonary artery systolic pressure; LVEDVi: indexed left ventricular end-diastolic volume; LVSVi: indexed left ventricular stroke volume; LVEF: left ventricular ejection fraction; LV GLS: left ventricular global longitudinal strain (on CMR);RVEDVi: indexed right ventricular end-diastolic volume; RVEF: right ventricular ejection fraction; RV SV/ESV: right ventricular stroke volume/end-systolic volume (surrogate of ventricular-arterial coupling)Abstract 6-016 Figure 1(A) Exercise cardiac index at 35W exercise in women and men; (B) Exercise eccentricity index (anteroposterior - septolateral ratio at mid left ventricular level) in women and menAbstract 6-016 Figure 2Sex-differences in impact of EAT on rest and exercise cardiac function",
  "authors": [
    {
      "affiliations": [
        "Oxford Centre for Clinical Magnetic Resonance Research (OCMR), UK"
      ],
      "name": "Sher May Ng"
    },
    {
      "affiliations": [
        "Oxford Centre for Clinical Magnetic Resonance Research (OCMR), UK"
      ],
      "name": "Jiliu Pan"
    },
    {
      "affiliations": [
        "Oxford Centre for Clinical Magnetic Resonance Research (OCMR), UK"
      ],
      "name": "Roshan Xavier"
    },
    {
      "affiliations": [
        "Oxford Centre for Clinical Magnetic Resonance Research (OCMR), UK"
      ],
      "name": "Jack Miller"
    },
    {
      "affiliations": [
        "Oxford Centre for Clinical Magnetic Resonance Research (OCMR), UK"
      ],
      "name": "Ladislav Valkovic"
    },
    {
      "affiliations": [
        "Oxford Centre for Clinical Magnetic Resonance Research (OCMR), UK"
      ],
      "name": "Andrew Lewis"
    },
    {
      "affiliations": [
        "Oxford Centre for Clinical Magnetic Resonance Research (OCMR), UK"
      ],
      "name": "Oliver Rider"
    }
  ],
  "title": "6-016 Sex-related differences in exercise phenotypes of individuals with heart failure with preserved ejection fraction (HFpEF): differential impact of epicardial adipose tissue",
  "uid": "52551914-7fb0-5c9f-92b4-c36fc576d7d9"
}