Sex Differences in the Pulmonary Artery Wedge Pressure Response to Exercise in Healthy Older Adults
Notice bibliographique
Résumé
Background Dyspnea with physical exertion is an important limitation in the aging population. A proportion of affected patients demonstrate marked increases in the pulmonary artery wedge pressure (PAWP) during exercise, which is thought to reflect latent abnormalities of left ventricular diastolic function or early Heart Failure with preserved ejection fraction (HFpEF). This condition demonstrates a clear female disposition. Although hemodynamic exercise testing is a promising means to identify this patient population, it is limited by lack of normal reference ranges. Our objectives were to 1) describe the PAWP response to exercise in healthy, community‐dwelling older adults and 2) examine whether there were sex differences with respect to this physiology. We hypothesized that compared to similarly aged men, post‐menopausal women would demonstrate an elevated PAWP in response to submaximal exercise. Methods Thirty‐six healthy volunteers [18 men (54 ± 7 years)/ 18 women (58 ± 6 years)] were studied at rest (control) and during two consecutive stages of semi‐upright cycle‐ergometry designed to elicit heart rates of approximately 100 bpm (Light Exercise) and 120 bpm (Moderate Exercise). Right heart catheterization was performed to measure pulmonary pressures, with simultaneous echocardiography. At each exercise intensity, pulmonary artery systolic, diastolic, mean, and wedge pressures were manually analyzed offline, beat‐by‐beat. Cardiac output (CO) and stroke volume (SV) were derived from thermodilution (n = 28) or Doppler echocardiography (n = 8). Results Exercise hemodynamic data are presented in . At control, PAWP was similar between men and women, while CO and SV tended to be lower in women even when indexed to body size. To achieve the same target HR at light and moderate exercise, workrates (WR) were smaller in women. At both light and moderate exercise, CO and SV increased, although they remained lower in women. Despite lower WR, CO, and SV in women, the pattern of the PAWP response was similar between sexes across both exercise intensities. PAWP increased at light exercise (17 ± 5 mmHg), with no further increase and a slight decline at moderate exercise (15 ± 5 mmHg). This occurred despite significantly elevated heart rate and CO throughout exercise. When indexed to exercise workrate (PAWR) or when adjusted as the ratio of PAWP to workload/body weight (PAWL), the PAWP response at light exercise was significantly higher in women compared to men. Although PAWR and PAWL then decreased from light to moderate exercise, they remained significantly elevated in women compared to men. Conclusion In healthy older adults, the PAWP response to submaximal exercise is complex, increasing during exercise then remaining stable or even declining as exercise intensity increases. Although the rise in the PAWP response to submaximal exercise appears similar in men and women, the increase in PAWP occurs despite lower CO and WR in women, even when adjusted for smaller body size. Women may be predisposed to effort‐related dyspnea based on relative pulmonary venous hypertension at lower exercise workload. Support or Funding Information This study was supported by the Heart & Stroke Foundation of Ontario. Exercise Hemodynamic Data Control Light Moderate WR (W) Men ‐ 49 ± 16 82 ± 21 Women ‐ 31 ± 18 53 ± 23, HR(bpm) Men 62 ± 7 102 ± 2 121 ± 2, Women 64 ± 8 104 ± 3 122 ± 3, CI (L/min/m 2 ) Men 2.8 ± 1 5.7 ± 1 6.6 ± 2, Women 2.5 ± 0.4 5.0 ± 1 5.7 ± 2 SVI (mL/m 1 ) Men 45 ± 11 56 ± 15 55 ± 16 Women 39 ± 8 48 ± 12 47 ± 10 PASP (mmHg) Men 25 ± 5 39 ± 9 37 ± 7 Women 25 ± 3 39 ± 7 37 ± 8 PADP (mmHg) Men 10 ± 3 16 ± 4 15 ± 4 Women 11 ± 3 17 ± 4 16 ± 5 mPAP (mmHg
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».