Gender-based Echocardiographic Patterns and Diastolic Dysfunction among Diabetic patients with HFpEF

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is characterized by the presence of clinical signs and symptoms with preserved LV systolic function (EF >50%), and demonstrable diastolic dysfunction. Echocardiographic evidence of DD typically includes an elevated E/e′ ratio, increased left atrial size, and elevated LVEDP. In addition, GLS, assessed via STE, has emerged as an important prognostic marker in HFpEF. Moreover, HFpEF is observed more commonly in women, a disparity that may be partly explained by differences in comorbid conditions, obesity, and hormonal influences.

Methods: This was a cross-sectional study done on 241 patients in Cardiac Center in Erbil, Iraq, from January 1st to June 1st, 2023. Patients with Type 2 DM, and angiographically proven to be non IHDs were all enrolled. Data processing and analysis was done using SPSS version 26. A p value < 0.05 was considered significant.

Results: Our sample included 241 patients, with a mean age of 55.2 ± 9.9 years. The female participants had a significantly higher BMI, higher prevalence of comorbidities, and lower rate of smoking. Compared to women, men had significantly higher mean LVEDD, LEVSD, IVSd, LVPWd, LA size, and lateral e’ and lower mean LVEF. There was a significant difference between genders in the proportion of patients with IVSd ≥ 10 mm. A significant correlation was noted between HbA1c and LVEDD, lateral e’, and GLS. Binary logistic regression revealed female gender to be a significant independent predictor of GLS being < 18%, but not MAPSE being ≤ 12 mm or E/e’ ratio being > 11.

Conclusion: Significant gender differences were noted in various echocardiographic parameters (LVEDD, LEVSD, LVSd, LVPWd, LA size, lateral e’, and LVEF). Female gender was found to be an independent predictor of subclinical systolic dysfunction as measured by GLS.