Among a large hospital-based sample of patients with HF, women and men exhibited similar indices of right ventricular function, despite women having worse pulmonary vascular function, and sex differences in hemodynamic measures were largely similar across individuals with HFpEF and HFrEF.
Key Findings
Results
Women with both HFpEF and HFrEF exhibited worse pulmonary vascular function, with significantly higher pulmonary vascular resistance and lower pulmonary artery compliance.
Multivariable-adjusted P<0.001 for both pulmonary vascular resistance and pulmonary artery compliance differences by sex
This finding was consistent across both HF subtypes (HFpEF and HFrEF)
The study used multivariable linear regression to adjust for confounders
Right heart catheterization was the invasive hemodynamic measurement modality used
Results
Women and men had similar measures of right ventricular function across both HF subtypes.
Multivariable-adjusted P>0.05 for all right ventricular function measures
This finding held across both HFpEF and HFrEF subgroups
Right ventricular function similarity persisted despite women showing worse pulmonary vascular function
Analysis was based on invasive right heart catheterization data
Results
Women with both HFpEF and HFrEF had similar cardiac power index compared to men, but higher aortic pulsatility index.
Aortic pulsatility index was higher in women with HFpEF (P=0.01) and HFrEF (P<0.001)
Cardiac power index was similar between sexes in both HFpEF and HFrEF
Aortic pulsatility index is an integrated hemodynamic measure reflecting the interaction between cardiac output and arterial pulsatility
These findings suggest sex differences in vascular-cardiac coupling rather than overall cardiac power output
Methods
The study population consisted of 1818 patients with heart failure who underwent clinically indicated right heart catheterization, with notable differences in sex distribution between HF subtypes.
709 individuals had HFpEF (44% women, mean age 68±10 years)
1109 individuals had HFrEF (26% women, mean age 64±12 years)
Women were proportionally more represented in HFpEF than HFrEF (44% vs. 26%)
This was a retrospective cohort study conducted at a hospital-based setting
Results
Sex differences in hemodynamic measures were largely similar in pattern across individuals with HFpEF and HFrEF.
Worse pulmonary vascular function in women was observed in both HF subtypes
Similar right ventricular function between sexes was observed in both HF subtypes
The consistency of sex differences across HF subtypes was a key secondary finding of the study
Authors note that future studies are needed to delineate clinical implications of these sex differences
What This Means
This research examined differences between women and men in detailed heart and lung blood vessel measurements taken during a procedure called right heart catheterization, which involves threading a catheter through the heart to measure pressures and blood flow. The study included 1,818 heart failure patients — 709 with heart failure where the heart's pumping function is preserved (HFpEF) and 1,109 where pumping function is reduced (HFrEF). The key finding was that while women and men had similar measurements of how well the right side of the heart was pumping, women in both groups showed signs of worse function in the blood vessels of the lungs — specifically, higher resistance to blood flow and lower ability of those vessels to expand with each heartbeat.
The study also found that women had higher values of a measurement called aortic pulsatility index, which reflects how the heart and large blood vessels interact, even though overall cardiac power output (how hard the heart is working) was similar between sexes. Notably, these patterns of sex differences were consistent whether patients had preserved or reduced heart function, suggesting that biology — not just the type of heart failure — plays a role in these differences.
This research suggests that the lungs' blood vessels may be particularly affected differently in women with heart failure compared to men, regardless of which type of heart failure they have. This could have implications for how clinicians monitor and potentially treat women with heart failure, though the authors emphasize that more research is needed to understand what these hemodynamic differences mean for patient outcomes and treatment approaches.
Guo M, Parekh J, Lau E, Kosyakovsky L, Mounsey L, Pomerantsev E, et al.. (2026). Sex Differences in Right Ventricular, Pulmonary Vascular, and Integrated Hemodynamic Measures of Cardiac Function in HFpEF and HFrEF.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.050009