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Interplay of sex hormones and long-term right ventricular adaptation in a Dutch PAH-cohort

Abstract : Background: To investigate the association between altered sex hormone expression and long-term right ventricular (RV) adaptation and progression of right heart failure in a Dutch cohort of Pulmonary Arterial Hypertension (PAH)-patients across a wide range of ages. Methods: In this study we included 279 PAH-patients, of which 169 females and 110 males. From 59 patients and 21 controls we collected plasma samples for sex hormone analysis. Right heart catheterization (RHC) and/or cardiac magnetic resonance (CMR) imaging was performed at baseline. For longitudinal data analysis, we selected patients that underwent a RHC and/or CMR maximally 1.5 years prior to an event (death or transplantation, N = 49). Results: Dehydroepiandrosterone-sulfate (DHEA-S) levels were reduced in male and female PAH-patients compared to controls, whereas androstenedione and testosterone were only reduced in female patients. Interestingly, low DHEA-S and high testosterone levels were correlated to worse RV function in male patients only. Subsequently, we analyzed prognosis and RV adaptation in females stratified by age. Females ≤45years had best prognosis in comparison to females ≥55years and males. No differences in RV function at baseline were observed, despite higher pressure-overload in females ≤45years. Longitudinal data demonstrated a clear distinction in RV adaptation. Although females ≤45years had an event at a later time point, RV function was more impaired at end-stage disease. Conclusions: Sex hormones are differently associated with RV function in male and female PAH-patients. DHEA-S appeared to be lower in male and female PAH-patients. Females ≤45years could persevere pressure-overload for a longer time, but had a more severe RV phenotype at end-stage disease.
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Contributor : Christophe Guignabert Connect in order to contact the contributor
Submitted on : Saturday, February 5, 2022 - 10:31:55 AM
Last modification on : Monday, February 21, 2022 - 3:10:03 PM
Long-term archiving on: : Friday, May 6, 2022 - 6:05:23 PM


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Jessie van Wezenbeek, Joanne A Groeneveldt, Aida Llucià-Valldeperas, Cathelijne E van Der Bruggen, Samara M A Jansen, et al.. Interplay of sex hormones and long-term right ventricular adaptation in a Dutch PAH-cohort. The Journal of Heart and Lung Transplantation, Elsevier, 2021, Online ahead of print. ⟨10.1016/j.healun.2021.11.004⟩. ⟨inserm-03558871⟩



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