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. 2020 Feb;7(1):213-222.
doi: 10.1002/ehf2.12557. Epub 2020 Jan 20.

The effect of parity on exercise physiology in women with heart failure with preserved ejection fraction

Anna L Beale  1   2   3 , Carmela Cosentino  3 , Louise Segan  2 , Justin A Mariani  1 , Donna Vizi  1 , Shona Evans  1 , Shane Nanayakkara  1   2   3 , David M Kaye  1   2   3
Affiliations

The effect of parity on exercise physiology in women with heart failure with preserved ejection fraction

Anna L Beale et al. ESC Heart Fail. 2020 Feb.

Abstract

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.

Keywords: Haemodynamics; Heart failure with preserved ejection fraction; Parity; Pregnancy; Sex characteristics.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Change in right atrial pressure, left, along with pulmonary capillary wedge pressure, right, with exercise according to parity category. PCWP, pulmonary capillary wedge pressure.
Figure 2
Figure 2
Change in pulmonary capillary wedge pressure with exercise indexed to workload in men and women according to parity category. PCWP, pulmonary capillary wedge pressure.
Figure 3
Figure 3
Rest and exercise left ventricular ejection fraction (LVEF) according to parity category.
Figure 4
Figure 4
Proposed mechanisms behind the association between multiparity and severity of exercise limitation in heart failure with preserved ejection fraction (HFpEF). LVEF, left ventricular ejection fraction; PCWP, pulmonary capillary wedge pressure; RA, right atrial.
See this image and copyright information in PMC

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