Key result
Higher parity is linked to ~67% greater exercise PCWP rise in women with HFpEF.
Why the study?
Women are overrepresented in HFpEF, but the mechanisms remain unclear, and the relationship between parity and exercise haemodynamics had not been examined.
Does a history of ≥3 births worsen rest and exercise haemodynamic and echocardiographic profiles in women with HFpEF?
Observational (n=58)
Does a history of ≥3 births worsen rest and exercise haemodynamic and echocardiographic profiles in women with HFpEF?
Higher parity (≥3 births) in women with HFpEF is associated with worse exercise hemodynamics, including poorer diastolic reserve and higher pulmonary vascular resistance, suggesting a potential mechanism for the female predominance in HFpEF.
Answers are grounded in this paper and cite their sources.
May flag worse exercise hemodynamics in HFpEF by parity; hypothesis-generating and should not yet change practice.
AIMS: Women are overrepresented amongst patients with heart failure with preserved ejection fraction (HFpEF); however, the underpinning mechanism for this asymmetric distribution is unclear. Pregnancy represents a potential gender-specific risk factor for HFpEF. It leads to significant physiological adaption, and increasing parity has been associated with some cardiovascular risk. We sought to examine the relationship between prior parity with the rest and exercise haemodynamic and echocardiographic profile of women with HFpEF. METHODS AND RESULTS: Patients referred for assessment of exertional dyspnoea and confirmed to have a haemodynamic and clinical profile consistent with HFpEF were included. Detailed evaluation consisted of rest and exercise right heart catheterization and echocardiography. A socio-economic and obstetric history was also documented. Fifty-eight women were assessed and categorized as having either 0-2 births or ≥3 births, dividing the cohort equally. Women with ≥3 births achieved a lower symptom-limited workload than those with 0-2 births [38 (24-51) vs. 46 (31-68) W, P = 0.04]. Women with ≥3 births had a greater rise in pulmonary capillary wedge pressure indexed to workload with exercise [0.5 (0.3-0.8) vs. 0.3 (0.2-0.5) mmHg/W, P = 0.03], paralleled by a greater rise in right atrial pressure [10 (8-12) vs. 7 (3-11), P = 0.01]. Pulmonary vascular resistance was also higher in women with ≥3 births [1.9 (1.6-2.4) vs. 1.6 (1.4-1.9) mmHg/L/min rest, P = 0.046, and 1.9 (2.4-2.4) vs. 1.4 (1-1.8) mmHg/L/min exercise, P = 0.024]. Left ventricular ejection fraction was lower at rest [60 (57-61) vs. 63 (60-66), P = 0.008] and during exercise [65 (62-67) vs. 68 (66-70), P = 0.038] in women with higher parity. CONCLUSIONS: Higher parity is associated with greater impairments in multiple physiologic parameters of HFpEF severity in women, including diastolic reserve, pulmonary vascular resistance, and systolic dysfunction.
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Beale et al. (2020) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=58). ≥3 births (parity) vs. 0-2 births was evaluated on Rise in pulmonary capillary wedge pressure indexed to workload with exercise (mmHg/W) (p=0.03). Women with HFpEF and ≥3 births had a greater rise in pulmonary capillary wedge pressure indexed to workload with exercise compared to those with 0-2 births (0.5 vs 0.3 mmHg/W, P=0.03).
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