Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Jun;145(6):1230-1236.
doi: 10.1378/chest.13-1291.

The right ventricle explains sex differences in survival in idiopathic pulmonary arterial hypertension

Wouter Jacobs  1 , Mariëlle C van de Veerdonk  2 , Pia Trip  2 , Frances de Man  2 , Martijn W Heymans  3 , Johannes T Marcus  4 , Steven M Kawut  5 , Harm-Jan Bogaard  2 , Anco Boonstra  2 , Anton Vonk Noordegraaf  6
Affiliations
Comparative Study

The right ventricle explains sex differences in survival in idiopathic pulmonary arterial hypertension

Wouter Jacobs et al. Chest. 2014 Jun.

Abstract

Background: Male sex is an independent predictor of worse survival in pulmonary arterial hypertension (PAH). This finding might be explained by more severe pulmonary vascular disease, worse right ventricular (RV) function, or different response to therapy. The aim of this study was to investigate the underlying cause of sex differences in survival in patients treated for PAH.

Methods: This was a retrospective cohort study of 101 patients with PAH (82 idiopathic, 15 heritable, four anorexigen associated) who were diagnosed at VU University Medical Centre between February 1999 and January 2011 and underwent right-sided heart catheterization and cardiac MRI to assess RV function. Change in pulmonary vascular resistance (PVR) was taken as a measure of treatment response in the pulmonary vasculature, whereas change in RV ejection fraction (RVEF) was used to assess RV response to therapy.

Results: PVR and RVEF were comparable between men and women at baseline; however, male patients had a worse transplant-free survival compared with female patients (P = .002). Although male and female patients showed a similar reduction in PVR after 1 year, RVEF improved in female patients, whereas it deteriorated in male patients. In a mediator analysis, after correcting for confounders, 39.0% of the difference in transplant-free survival between men and women was mediated through changes in RVEF after initiating PAH medical therapies.

Conclusions: This study suggests that differences in RVEF response with initiation of medical therapy in idiopathic PAH explain a significant portion of the worse survival seen in men.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Transplant-free survival in male (solid line) and female (dashed line) patients with pulmonary arterial hypertension starting first-line pulmonary arterial hypertension-specific therapies (P = .002).
See this image and copyright information in PMC

Comment in

References

    1. Galiè N, Hoeper MM, Humbert M, et al. ; ESC Committee for Practice Guidelines (CPG). Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2009;30(20):2493-2537 - PubMed
    1. van Wolferen SA, Marcus JT, Boonstra A, et al. Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J. 2007;28(10):1250-1257 - PubMed
    1. Thenappan T, Shah SJ, Rich S, Gomberg-Maitland M. A USA-based registry for pulmonary arterial hypertension: 1982-2006. Eur Respir J. 2007;30(6):1103-1110 - PubMed
    1. Gomberg-Maitland M, Dufton C, Oudiz RJ, Benza RL. Compelling evidence of long-term outcomes in pulmonary arterial hypertension? A clinical perspective. J Am Coll Cardiol. 2011;57(9):1053-1061 - PubMed
    1. Kawut SM, Horn EM, Berekashvili KK, et al. New predictors of outcome in idiopathic pulmonary arterial hypertension. Am J Cardiol. 2005;95(2):199-203 - PubMed

Publication types

MeSH terms