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Publications

Journal Article Review Epublish 8 citations

PubMed: 40558648 DOI: 10.3390/jcdd12060213

Gender-Specific Differences in Diastolic Dysfunction and HFpEF: Pathophysiology, Diagnosis, and Therapeutic Strategies.

J Cardiovasc Dev Dis 12(6)

Authors: Francesca Coppi, Gianluca Pagnoni, Francesca Grossule, Ashraf Nassar, Arianna Maini, Giuseppe Masaracchia, Francesco Sbarra, Elisa Battigaglia, Enrico Maggio, Daniela Aschieri, Federica Moscucci, Marcello Pinti, Anna Vittoria Mattioli, Francesco Fedele, Susanna Sciomer

Affiliations

  • Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy.
  • National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy.
  • Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy.
  • Cardiology Division, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy.
  • Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy.
  • Dipartimento di Scienze Cliniche, "Sapienza" Università degli studi di Roma, 00185 Rome, Italy.
  • Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Campi 287, 41125 Modena, Italy.
  • Department of Quality of Life, University of Bologna-Alma Mater Studiorum, 40126 Bologna, Italy.
  • Emeritus of Cardiology, Sapienza University of Rome, 00185 Rome, Italy.
  • National Institute for Cardiovascular Research (INRC), 40138 Bologna, Italy.

Abstract

Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of heart failure cases and is primarily characterized by impaired diastolic function, leading to increased ventricular filling pressures and symptoms like dyspnea and reduced exercise tolerance. Significant gender-specific differences are observed, with women, particularly post-menopausal, experiencing higher prevalence and distinct clinical profiles compared to men. Diastolic dysfunction in HFpEF involves altered cellular mechanisms such as reduced SERCA2a expression, impacting calcium handling and myocardial relaxation. Diagnostic strategies mainly employ echocardiography, including Doppler imaging, tissue Doppler imaging, and strain imaging, to assess ventricular relaxation and stiffness. However, early identification remains challenging, necessitating advanced tools like cardiac magnetic resonance and exercise stress testing for accurate diagnosis, especially in women who often present with subtle symptoms. Treatment options for HFpEF have traditionally been limited, but recent trials, notably EMPEROR-PRESERVED and DELIVER, demonstrated significant cardiovascular benefits using sodium-glucose cotransporter-2 (SGLT2) inhibitors. Additionally, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown promising results, particularly in obese patients. Despite these advances, gender differences in therapeutic response necessitate further research for personalized management strategies. Understanding sex-specific pathophysiological mechanisms and optimizing diagnostic criteria remain essential to improving prognosis and quality of life in HFpEF patients.

MeSH

Exercise, Glucagon-Like Peptide 1, Heart Failure, Heart Failure, Diastolic, Signs And Symptoms, Sex Characteristics, Echocardiography, Diagnosis, Therapeutics, Sex Differences