SPC365

Comprehensive Assessment of Sex Differences in Left-Ventricular Systolic Function: Insights from Strain and Myocardial Work

Session: Sessão de Posters 52 - Função auricular, interação ventricular e fenotipagem miocárdica
Speaker: Luís Cotrim

Congress: CPC 2026
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Luís Cotrim; Lígia Mendes
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction:&nbsp;</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Sex-related differences in myocardial structure and ventricular geometry may influence global systolic performance. While echocardiographic indices like Left-Ventricular Ejection Fraction (LVEF), Global Longitudinal Strain (GLS), and Myocardial Work (MW) provide complementary insights into systolic function, it remains unclear whether these parameters differ between men and women independently of cardiovascular risk factors.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:&nbsp;</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">This cross-sectional study evaluated sex differences in resting LVEF, GLS, and MW indices in a large cohort of 1219 adults undergoing routine echocardiography (639 men, 580 women). Non-parametric analyses were performed due to non-normal data distribution. Multivariable linear regression was used to adjust for major clinical confounders, including age, BMI, diabetes, dyslipidemia, and hypertension.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">The median age was similar in both sexes (64 years, IQR 14&ndash;16 years).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Unadjusted analyses showed women exhibited&nbsp;</span></span></span></span><!--StartFragment -->slightly higher LVEF (59.0 vs. 58.7%, p=0.393)<!--EndFragment -->,<span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> significantly more negative GLS (median&nbsp; -17.0 vs. -16.0, p=0.0037), higher Global Work Index (GWI) (median 1536 vs. 1457 mmHg%, p=0.00127), and higher Global Constructive Work (GCW) median 1943 vs. 1810.5 mmHg%, p=0.00234). Global Wasted Work (GWW) was also higher in women, but Global Work Efficiency (GWE) did not differ (median 93.0% in both groups).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Multivariable linear regression confirmed that female sex was independently associated with a more negative GLS (</span></span><span style="font-size:10.0pt"><span style="font-family:Symbol">b</span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">= -0.97, p=0.0179), higher GWI (</span></span><span style="font-size:10.0pt"><span style="font-family:Symbol">b</span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> = +119.12 mmHg%, p=0.000122), and higher GCW (</span></span><span style="font-size:10.0pt"><span style="font-family:Symbol">b</span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">= +135.42 mmHg%, p=0.00184).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Crucially, the unadjusted difference in GWW disappeared after covariate adjustment (</span></span><span style="font-size:10.0pt"><span style="font-family:Symbol">b</span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">= +14.36, p=0.345), indicating the absence of an independent sex effect on mechanical inefficiency.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">These findings demonstrate that women exhibit intrinsically enhanced longitudinal deformation and greater constructive myocardial work at rest compared to men, even after adjusting for major clinical confounders. This physiological difference is not accompanied by a difference in mechanical efficiency or wasted work. This profile is consistent with known sex-specific differences in myocardial fiber architecture.</span></span></span></span></p>