Gender-specific features of cardiac remodeling in patients with pulmonary embolism

Abstract

The aim – determination of gender characteristics of cardiac remodeling within a year after PE.
Materials and methods. The study involved 97 patients who were consecutively hospitalized at the KNP «City Clinical Hospital No. 8» of the Kharkiv City Council from January 1, 2023 to January 1, 2024 with a diagnosis of PE, verified according to multispiral computed tomography angiography of the pulmonary vessels, who underwent echocardiography on the first day of hospitalization. Patient analysis was performed at initial admission with acute PE and after 12 months of follow-up. Clinical and anamnestic, laboratory and instrumental indicators were analyzed, and statistical analysis of data was performed depending on gender.
Results and discussion. Comparative analysis of echocardiogram data depending on gender at hospitalization predictably revealed significantly larger sizes and volumes of the left ventricle in men compared to women (EDD: 48.38±7.06 mm vs. 42.87±6.55 mm, p=0.00017; ESD: 33.40±8.80 mm vs. 29.65±5.09 mm, p=0.014; EDV: 110.16±26.51 ml vs. 86.28±22.94 ml, p=0.0012; EDVI: 51.92±10.75 ml/m2 vs. 43.90±11.64 ml/m2, p=0.016; ESV: 51.17±25.27 ml vs. 33.26±12.50 ml, p=0.0017 and ESVI: 23.92±11.48 ml/m2 vs. 16.85±6.07 ml/m2, p=0.0062, respectively). At the same time, no significant differences in the indicators of the right heart at the beginning of the observation were detected. The analysis of the features of heart recovery depending on gender showed that it was for men after 12 months of observation that there was a significantly better and faster recovery of such indicators as RAVI (p=0.043) and sPAP (p=0.028), while no significant difference was found among other indicators.
Conclusions. According to the results of a comparative analysis of the dynamics of echocardiographic indicators in patients with PE depending on gender, it was found that the restoration of the structure and function of the heart after a year is more pronounced in men. The signs of damage to the right parts of the heart in PE are more significant in women, as evidenced by a larger right atrial volume index and pulmonary artery systolic pressure, as well as a lower index of the maximum systolic longitudinal strain of the middle and apical sections of the RV free wall. According to the results of multivariate logistic regression analysis, additional independent factors influencing the slowdown of the recovery of the right heart sections in both men and women are the advanced age of the patients, the presence of excess weight, coronary heart disease, and chronic kidney disease in the anamnesis. In men, oncology was an additional factor, and in women – diabetes, hypertensive disease, congestive heart and respiratory failure.