Gender peculiarities of cardiac remodelling in patients with pulmonary embolism

Abstract Introduction Pulmonary embolism (PE) is a critical and potentially dangerous condition, the course of which is characterized by structural and functional changes in the heart, mainly in its right sections. Despite the proven influence of gender on cardiac remodeling in various pathological conditions, these issues have not been sufficiently studied in PE. Purpose of our study was to determine gender-specific characteristics of cardiac remodeling in the acute period and within a year after PE. Methods A prospective analysis of 97 patients who were consecutively admitted to clinical hospital from 01/01/2023 to 01/01/2024 with a diagnosis of PE verified by MSCT angiography of the pulmonary vessels was performed. Patients were examined upon admission to the hospital and after 12 months of follow-up. Results 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. It has been established that the restoration of the structure and function of the right ventricle 12 months after a PE is more clearly observed in men, compared to women (Picture 1 - Changes in ultrasound examination indicators 12 months after PE depending on gender, in %). 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), mPAP (p=0.028) and LVESV (p=0.024), while no significant difference was found among other indicators. Based on Spearman's rank correlation and multifactor logistic regression analysis, we identified common factors associated with the lack of restoration of heart structures in both men and women - advanced age of patients, presence of excess weight, ischemic heart disease, chronic kidney disease. In men, an additional factor was cancer, and in women – diabetes, hypertension, congestive heart and respiratory failure. Conclusion There are gender differences in the expressiveness of heart recovery one year after PE, and in factors associated with the lack of positive dynamics.Changes 12 months after PE on gender, %