{
  "abstract": "Introduction Women have been historically underrepresented in cardiovascular research, and consequently, are less likely to receive evidence-based therapies, have a higher symptom burden and report a worse quality of life. Although sex-differences in the epidemiology of heart failure (HF) have been established, whether these differences are due to discrepancies in cardiac energetics and function between men and women is still unknown. The pressure-volume loop (PVL) provides an integrated assessment of cardiac energetics, loading conditions, and contractility. This study aims to identify mechanistic sex differences in HF using cardiac magnetic resonance (CMR) derived, non-invasive PVL analysis, and to explore the association between these sex differences and symptom burden.Methods HF patients were recruited from the Leeds MATCH registry, and their CMR left ventricular (LV) volumetric data and blood pressure readings were analysed to map PVLs. Sex-differences were assessed across HF phenotypes (HFpEF: Heart Failure with Preserved Ejection Fraction, HFmEF: Heart Failure with Moderately Reduced Ejection Fraction, HFrEF: Heart Failure with Reduced Ejection Fraction) [ table 1, figure 1]. Logistic regression assessed associations between sex, PVL metrics, age, and symptom burden. Cross-sectional analysis examined sex differences in PVL metrics across age groups [figure 2].Results PVL metrics differed significantly between men and women. After indexing by body surface area, women had a higher arterial elastance (HFpEF: 1.6±0.5 vs 1.3±0.3 mmHg/ml, P <0.001; HFmEF: 1.8±0.5 vs 1.5±0.4 mmHg/ml, P <0.01; 2.2±1.1 vs 1.9±0.7 mmHg/ml, P 0.219) and end-systolic elastance (HFpEF: 2.2±1.0 vs 1.7±0.5 mmHg/ml, P <0.001; HFmEF: 1.5±0.4 vs 1.2±0.3 mmHg/ml, P <0.001; HFrEF: 0.9±0.3 vs 0.7±0.3 mmHg/ml, P <0.001) than men [ figure 1]. Female sex (OR: 1.95, 95% CI: 1.38 to 2.77, P <0.0001) and PVL parameters were independently associated with severity of symptoms and impairments to daily activities. From age 45-55 years, coinciding with the average age of menopause, arterial elastance became higher in women than men [figure 2].Conclusions Across HF subtypes, women have a higher afterload and contractility compared with men. These differences were associated with age and symptom burden and became more pronounced after the average age of menopause. Findings suggest that sex-specific differences in afterload and contractility may influence HF pathophysiology and symptom burden.Abstract 458 Table 1Sex-differences in PVL Analysis. A comparison of indexed CMR derived PVL metrics between men and women with HFVariableFemale (n = 268)Male (n = 473)P-ValueIndexed Arterial Elastance* (mmHg/ml/m2)1.19 ± 0.50 0.98 ± 0.37<0.001Indexed End-Systolic Elastance* (mmHg/ml/m2) 0.98 ± 0.560.58 ± 0.28<0.001Indexed Potential Energy* (mmHg:ml/m2)0.50 ± 0.230.65 ± 0.28<0.001Indexed Stroke Work* (mmHg:ml/m2)0.73 ± 0.260.72 ± 0.280.61Indexed Static Left Ventricular Compliance* (ml/mmHg/m2) 6.68 ± 1.797.39 ± 2.02<0.001Indexed Efficiency* (%)37.61 ± 9.5630.30 ± 8.35<0.001Abbreviations: Cardiovascular Magnetic Resonance (CMR), Pressure-Volume Loop (PVL). *Indexed to Body Surface Area (BSA, m2).Abstract 458 Figure 1Sex differences in PVL analysis across Heart Failure Phenotypes (Indexed). Boxplot comparing PVL metrics indexed by BSA between men and women with HFpEF, HFmEF and HFrEF. Abbreviations: Heart failure with preserved ejection fraction (HFpEF), Heart failure with moderately reduced ejection fraction (HFmEF), Heart failure with reduced ejection fraction (HFrEF), Standard deviation (SD), Interquartile range (IQR)Abstract 458 Figure 2Key findings from cross sectional analysis of PVL metrics across age groups, and investigation of association between PVL metrics, age and female sex with HF symptom burden. Female sex (OR: 1.95, 95% CI: 1.38 to 2.77, P <0.0001) and PVL parameters were independently associated with severity of symptoms and impairments to daily activities. From age 45-55 years, coinciding with the average age of menopause, arterial elastance became higher in women than men. Abbreviations: Pressure-Volume Loop (PVL), Heart Failure (HF), Odds Ratio (OR), Confidence Interval (CI), Left Ventricle (LV), New York Heart Failure Association (NYHA)",
  "authors": [
    {
      "affiliations": [
        "University of East Anglia, Norwich, United Kingdom"
      ],
      "name": "Tiya Bali"
    }
  ],
  "title": "458 Non-invasive pressure-volume loop analysis reveals sex differences in heart failure",
  "uid": "0e2a04a7-7b07-527e-9e29-7434faaeb9f1"
}