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. 2014 Feb;43(2):523-30.
doi: 10.1183/09031936.00027613. Epub 2013 Aug 15.

Sex and haemodynamics in pulmonary arterial hypertension

Corey E Ventetuolo  1 , Amy Praestgaard, Harold I Palevsky, James R Klinger, Scott D Halpern, Steven M Kawut
Affiliations

Sex and haemodynamics in pulmonary arterial hypertension

Corey E Ventetuolo et al. Eur Respir J. 2014 Feb.

Abstract

Female sex is a risk factor for pulmonary arterial hypertension (PAH), yet females have better survival than males. We sought to determine if sex was associated with baseline haemodynamics in subjects with PAH, and whether age modified these relationships. We conducted a pooled analysis from 11 randomised trials submitted to the US Food and Drug Administration. The study sample included 1211 subjects with idiopathic PAH, 25% of whom were males, and 489 subjects with connective tissue disease-associated PAH, 13% of whom were males. After multivariable adjustment, right atrial pressure was 1.36 mmHg higher (95% CI 0.44-2.27, p=0.004), cardiac index was -0.14 L · min(-1) · m(-2) lower (95% CI -0.23-0.04, p=0.01) and pulmonary vascular resistance was 1.23 Wood units higher (95% CI 0.18-2.27, p=0.02) in males compared with females. Younger males had 5.43 mmHg (95% CI 2.20-8.66, p=0.001) higher mean pulmonary arterial pressures than younger females, but these relationships were attenuated after age 45 years. In the subgroup of connective tissue disease-associated PAH, males may have had higher right atrial pressure. These findings implicate age as a modifier and provide further evidence of sexual dimorphism in PAH.

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Conflict of interest statement

Conflict of interest: Disclosures can be found alongside the online version of this article at www.erj.ersjournals.com

Figures

FIGURE 1
FIGURE 1
Study sample. RCT: randomised controlled trial; PHIRST: Pulmonary Arterial Hypertension and Response to Tadalafil; CTD: connective tissue disease; PAH: pulmonary arterial hypertension.
FIGURE 2
FIGURE 2
Least-square means of baseline haemodynamics a) mean pulmonary artery pressure (mPAP), b) cardiac output (CO) and c) pulmonary vascular resistance (PVR) by sex and age with adjustment for race, height, weight and study in subjects with idiopathic pulmonary arterial hypertension. Markers show the point estimates and whiskers the 95% confidence interval.
See this image and copyright information in PMC

Comment in

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