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Guo M, Diaz‐Canestro C, Pugliese NR, Paneni F, Montero D. Lean body mass and the cardiorespiratory phenotype: An ethnic-specific relationship in Hans Chinese women and men. J Cachexia Sarcopenia Muscle 2024; 15:963-974. [PMID: 38632694 PMCID: PMC11154775 DOI: 10.1002/jcsm.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/27/2023] [Accepted: 01/14/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Lean body mass (LBM) and the functional capacity of cardiovascular (CV) and respiratory systems constitute a female-specific relationship in European-American individuals. Whether this recent finding be extrapolated to the world's largest ethnic group, that is, Hans Chinese (HC, a population characterized by low LBM), is unknown. METHODS Healthy HC adults (n = 144, 50% ♀) closely matched by sex, age and physical activity were included. Total and regional (leg, arm and trunk) LBM and body composition were measured via dual-energy X-ray absorptiometry. Cardiac structure, stiffness, central/peripheral haemodynamics and peak O2 consumption (VO2peak) were assessed via transthoracic echocardiography and pulmonary gas analyses at rest and during exercise up to peak effort. Regression analyses determined the sex-specific relationship of LBM with cardiac and aerobic phenotypes. RESULTS Total and regional LBM were lower and body fat percentage higher in women compared with men (P < 0.001). In both sexes, total LBM positively associated with left ventricular (LV) mass and peak volumes (r ≥ 0.33, P ≤ 0.005) and negatively with LV end-systolic and central arterial stiffness (r ≥ -0.34, P ≤ 0.004). Total LBM strongly associated with VO2peak (r ≥ 0.60, P < 0.001) and peak cardiac output (r ≥ 0.40, P < 0.001) in women and men. Among regional LBM, leg LBM prominently associated with the arterio-venous O2 difference at peak exercise in both sexes (r ≥ 0.43, P < 0.001). Adjustment by adiposity or CV risk factors did not modify the results. CONCLUSIONS LBM independently determines internal cardiac dimensions, ventricular mass, distensibility and the capacity to deliver and consume O2 in HC adults irrespective of sex.
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Affiliation(s)
- Meihan Guo
- Faculty of MedicineHong Kong UniversityHong Kong
| | - Candela Diaz‐Canestro
- Faculty of MedicineHong Kong UniversityHong Kong
- Department of Medicine, School of Clinical MedicineHong Kong UniversityHong Kong
| | | | - Francesco Paneni
- Center for Translational and Experimental Cardiology (CTEC), Zurich University HospitalUniversity of ZurichZurichSwitzerland
- University Heart Center, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - David Montero
- Faculty of MedicineHong Kong UniversityHong Kong
- Department of Medicine, School of Clinical MedicineHong Kong UniversityHong Kong
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Jensen EK, Bøgevig S, Balchen T, Springborg AH, Royal MA, Storgaard IK, Lund TM, Møller K, Werner MU. Dose safety and pharmacodynamics of subcutaneous bupivacaine in a novel extended-release microparticle formulation: A phase 1, dose-ascending study in male volunteers. Basic Clin Pharmacol Toxicol 2024; 134:657-675. [PMID: 38482995 DOI: 10.1111/bcpt.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 04/17/2024]
Abstract
A novel microparticle-based extended-release local anaesthetic containing a bupivacaine/poly-lactic-co-glycolic acid (PLGA; LIQ865A) or plain bupivacaine (LIQ865B) was examined in a first-in-human trial. The objectives were to examine the dose safety/tolerability and pharmacodynamics. Randomized subcutaneous injections of LIQ865A (n = 16) or LIQ865B (n = 12) and diluent, contralaterally, were administered in a dose-ascending manner (150- to 600-mg bupivacaine). Subjects were admitted 24 h post-injection and followed for 30 days post-injection. The risk ratios (RRs; 95% CI) of erythematous reactions for LIQ865A versus diluent was 9.00 (1.81-52.23; P = 0.006) and for LIQ865B versus diluent 2.50 (0.69-9.94; P = 0.37). The RR for the development of hematomas (LIQ865A versus diluent) were 3.25 (1.52-8.16; P = 0.004) and 4.00 (0.72-24.89; P = 0.32) (LIQ865B versus diluent). Subcutaneous indurations persisting for 4-13 weeks were seen in 6/16 subjects receiving LIQ865A. One subject receiving LIQ865A (600-mg bupivacaine) developed intermittent central nervous system (CNS) symptoms of local anaesthetic systemic toxicity (85 min to 51 h post-injection) coinciding with plasma peak bupivacaine concentrations (490-533 ng/ml). Both LIQ865 formulations demonstrated dose-dependent hypoesthesia and hypoalgesia. The duration of analgesia ranged between 37 and 86 h. The overall number of local adverse events, however, prohibits clinical application without further pharmacological modifications.
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Affiliation(s)
- Elisabeth Kjær Jensen
- Department of Anesthesia, Pain and Respiratory Support, Neuroscience Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- DanTrials, Zelo Phase 1 Unit, Copenhagen University Hospitals-Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Bøgevig
- Department of Clinical Pharmacology, Copenhagen University Hospitals-Bispebjerg Hospital, Copenhagen, Denmark
| | - Torben Balchen
- DanTrials, Zelo Phase 1 Unit, Copenhagen University Hospitals-Bispebjerg Hospital, Copenhagen, Denmark
| | - Anders Holten Springborg
- Department of Anesthesia, Pain and Respiratory Support, Neuroscience Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- DanTrials, Zelo Phase 1 Unit, Copenhagen University Hospitals-Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Ida Klitzing Storgaard
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Trine Meldgaard Lund
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, Neuroscience Center, Copenhagen University Hospitals-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mads Utke Werner
- Department of Anesthesia, Pain and Respiratory Support, Neuroscience Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- DanTrials, Zelo Phase 1 Unit, Copenhagen University Hospitals-Bispebjerg Hospital, Copenhagen, Denmark
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Ji H, Gulati M, Huang TY, Kwan AC, Ouyang D, Ebinger JE, Casaletto K, Moreau KL, Skali H, Cheng S. Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality. J Am Coll Cardiol 2024; 83:783-793. [PMID: 38383092 PMCID: PMC10984219 DOI: 10.1016/j.jacc.2023.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Although physical activity is widely recommended for reducing cardiovascular and all-cause mortality risks, female individuals consistently lag behind male individuals in exercise engagement. OBJECTIVES The goal of this study was to evaluate whether physical activity derived health benefits may differ by sex. METHODS In a prospective study of 412,413 U.S. adults (55% female, age 44 ± 17 years) who provided survey data on leisure-time physical activity, we examined sex-specific multivariable-adjusted associations of physical activity measures (frequency, duration, intensity, type) with all-cause and cardiovascular mortality from 1997 through 2019. RESULTS During 4,911,178 person-years of follow-up, there were 39,935 all-cause deaths including 11,670 cardiovascular deaths. Regular leisure-time physical activity compared with inactivity was associated with 24% (HR: 0.76; 95% CI: 0.73-0.80) and 15% (HR: 0.85; 95% CI: 0.82-0.89) lower risk of all-cause mortality in women and men, respectively (Wald F = 12.0, sex interaction P < 0.001). Men reached their maximal survival benefit of HR 0.81 from 300 min/wk of moderate-to-vigorous physical activity, whereas women achieved similar benefit at 140 min/wk and then continued to reach a maximum survival benefit of HR 0.76 also at ∼300 min/wk. Sex-specific findings were similar for cardiovascular death (Wald F = 20.1, sex interaction P < 0.001) and consistent across all measures of aerobic activity as well as muscle strengthening activity (Wald F = 6.7, sex interaction P = 0.009). CONCLUSIONS Women compared with men derived greater gains in all-cause and cardiovascular mortality risk reduction from equivalent doses of leisure-time physical activity. These findings could enhance efforts to close the "gender gap" by motivating especially women to engage in any regular leisure-time physical activity.
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Affiliation(s)
- Hongwei Ji
- Tsinghua Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Martha Gulati
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tzu Yu Huang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alan C Kwan
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - David Ouyang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joseph E Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kaitlin Casaletto
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Kerrie L Moreau
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA; Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Hicham Skali
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Souza ACDAH, Rosenthal MH, Moura FA, Divakaran S, Osborne MT, Hainer J, Dorbala S, Blankstein R, Di Carli MF, Taqueti VR. Body Composition, Coronary Microvascular Dysfunction, and Future Risk of Cardiovascular Events Including Heart Failure. JACC Cardiovasc Imaging 2024; 17:179-191. [PMID: 37768241 PMCID: PMC10922555 DOI: 10.1016/j.jcmg.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Body mass index (BMI) is a controversial marker of cardiovascular prognosis, especially in women. Coronary microvascular dysfunction (CMD) is prevalent in obese patients and a better discriminator of risk than BMI, but its association with body composition is unknown. OBJECTIVES The authors used a deep learning model for body composition analysis to investigate the relationship between CMD, skeletal muscle (SM), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT), and their contribution to adverse outcomes in patients referred for evaluation of coronary artery disease. METHODS Consecutive patients (n = 400) with normal perfusion and preserved left ventricular ejection fraction on cardiac stress positron emission tomography were followed (median, 6.0 years) for major adverse events, including death and hospitalization for myocardial infarction or heart failure. Coronary flow reserve (CFR) was quantified as stress/rest myocardial blood flow from positron emission tomography. SM, SAT, and VAT cross-sectional areas were extracted from abdominal computed tomography at the third lumbar vertebra using a validated automated algorithm. RESULTS Median age was 63, 71% were female, 50% non-White, and 50% obese. Compared with the nonobese, patients with obesity (BMI: 30.0-68.4 kg/m2) had higher SAT, VAT, and SM, and lower CFR (all P < 0.001). In adjusted analyses, decreased SM but not increased SAT or VAT was significantly associated with CMD (CFR <2; OR: 1.38; 95% CI: 1.08-1.75 per -10 cm2/m2 SM index; P < 0.01). Both lower CFR and SM, but not higher SAT or VAT, were independently associated with adverse events (HR: 1.83; 95% CI: 1.25-2.68 per -1 U CFR and HR: 1.53; 95% CI: 1.20-1.96 per -10 cm2/m2 SM index, respectively; P < 0.002 for both), especially heart failure hospitalization (HR: 2.36; 95% CI: 1.31-4.24 per -1 U CFR and HR: 1.87; 95% CI: 1.30-2.69 per -10 cm2/m2 SM index; P < 0.004 for both). There was a significant interaction between CFR and SM (adjusted P = 0.026), such that patients with CMD and sarcopenia demonstrated the highest rate of adverse events, especially among young, female, and obese patients (all P < 0.005). CONCLUSIONS In a predominantly female cohort of patients without flow-limiting coronary artery disease, deficient muscularity, not excess adiposity, was independently associated with CMD and future adverse outcomes, especially heart failure. In patients with suspected ischemia and no obstructive coronary artery disease, characterization of lean body mass and coronary microvascular function may help to distinguish obese phenotypes at risk for cardiovascular events.
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Affiliation(s)
- Ana Carolina do A H Souza
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael H Rosenthal
- Department of Imaging, Dana-Farber Cancer Institute, and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Filipe A Moura
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sanjay Divakaran
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center and Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Guo M, Diaz-Canestro C, Ng MY, Yiu KH, Montero D. The Chinese cardiorespiratory and circulatory system at work in women and men: a case-control study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100975. [PMID: 38058739 PMCID: PMC10696127 DOI: 10.1016/j.lanwpc.2023.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 12/08/2023]
Abstract
Background The physiology of prominent prognostic factors in the cardiorespiratory system remains unchartered in the world's largest ethnic group: Hans Chinese (HC). This study assessed and contrasted the fundamental variables in HC and European-American (EA) individuals. Methods Healthy HC and EA adults (n = 140, 43% ♀) closely matched by age, sex and physical activity were included. Body composition (DXA) and haematological variables (haemoglobin mass, blood volume (BV)) were measured at rest. Pulmonary O2 uptake (VO2) measurements along with cycle ergometry designed for accurate transthoracic echocardiography were implemented to assess cardiorespiratory structure/function up to peak effort. Findings HC presented with higher body fat and lower lean body mass (LBM) percentage than EA irrespective of sex (P ≤ 0.014). BV did not differ whereas blood haemoglobin concentration was lower in HC compared with EA, particularly in females (P = 0.009). Myocardial diastolic and overall function at rest was enhanced in HC versus EA (P < 0.001). During exercise, heart volumes and output per unit of body size did not differ between ethnicities, whereas larger heart volumes per unit of LBM were found in HC versus EA in females (P ≤ 0.003). At high exercise intensities, VO2 (-16%) and the arteriovenous O2 difference (-28%) were markedly reduced in HC compared with EA in females (P ≤ 0.024). In males, no physiological difference between HC and EA was observed during exercise. Interpretation Notwithstanding lower LBM, HC are characterised by similar BV and cardiac capacity but reduced peak VO2 than EA in females, partly explained by low ethnic-specific blood O2 carrying capacity. Funding Early Career Scheme (106210224, to D.M.) and Seed Fund (104006024, to D.M.).
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Affiliation(s)
- Meihan Guo
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Ming-Yen Ng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Diagnostic Radiology, HKU-Shenzhen Hospital and Li Ka Shing Faculty of Medicine, The University of Hong Kong, Shenzhen, Hong Kong, China
| | - Kai Hang Yiu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - David Montero
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
- Libin Cardiovascular Institute of Alberta, University of Calgary, Canada
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Guo M, Diaz-Canestro C, Montero D. Blood Volume Explains the Relationship of Lean Body Mass With the Cardiovascular System in Men but Not in Women. Mayo Clin Proc 2024; 99:174-176. [PMID: 38176827 DOI: 10.1016/j.mayocp.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Meihan Guo
- School of Public Health, The University of Hong Kong, Hong Kong, China; Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Candela Diaz-Canestro
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China
| | - David Montero
- School of Public Health, The University of Hong Kong, Hong Kong, China; Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
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Keshvani N, Shah S, Ayodele I, Chiswell K, Alhanti B, Allen L, Greene SJ, Yancy C, Alonso W, Van Spall H, Fonarow GC, Heidenreich PA, Pandey A. Sex differences in long-term outcomes following acute heart failure hospitalization: Findings from the Get With The Guidelines-Heart Failure registry. Eur J Heart Fail 2023; 25:1544-1554. [PMID: 37632339 PMCID: PMC11069419 DOI: 10.1002/ejhf.3003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023] Open
Abstract
AIMS Sex differences in long-term outcomes following hospitalization for heart failure (HF) across ejection fraction (EF) subtypes are not well described. In this study, we evaluated the risk of mortality and rehospitalization among males and females across the spectrum of EF over 5 years of follow-up following an index HF hospitalization event. METHODS AND RESULTS Patients hospitalized with HF between 1 January 2006 and 31 December 2014 from the American Heart Association's Get With The Guidelines-Heart Failure registry with available 5-year follow-up using Medicare Part A claims data were included. The association between sex and risk of mortality and readmission over a 5-year follow-up period for each HF subtype (HF with reduced EF [HFrEF, EF ≤40%], HF with mildly reduced EF [HFmrEF, EF 41-49%], and HF with preserved EF [HFpEF, EF >50%]) was assessed using adjusted Cox models. The effect modification by the HF subtype for the association between sex and outcomes was assessed by including multiplicative interaction terms in the models. A total of 155 670 patients (median age: 81 years, 53.4% female) were included. Over 5-year follow-up, males and females had comparably poor survival post-discharge; however, females (vs. males) had greater years of survival lost to HF compared with the median age- and sex-matched US population (HFpEF: 17.0 vs. 14.6 years; HFrEF: 17.3 vs. 15.1 years; HFmrEF: 17.7 vs. 14.6 years for age group 65-69 years). In adjusted analysis, females (vs. males) had a lower risk of 5-year mortality (adjusted hazard ratio [aHR] 0.89, 95% confidence interval [CI] 0.87-0.90, p < 0.0001), and the risk difference was most pronounced among patients with HFrEF (aHR 0.87, 95% CI 0.85-0.89; pinteraction [sex*HF subtype] = 0.04). Females (vs. males) had a higher adjusted risk of HF readmission over 5-year follow-up (aHR 1.06, 95% CI 1.04-1.08, p < 0.0001), with the risk difference most pronounced among patients with HFpEF (aHR 1.11, 95% CI 1.07-1.14; pinteraction [sex*HF subtype] = 0.001). CONCLUSIONS While females (vs. males) had lower adjusted mortality, females experienced a significantly greater loss in survival time than the median age- and sex-matched US population and had a greater risk of rehospitalization over 5 years following HF hospitalization.
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Affiliation(s)
- Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Sonia Shah
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | | | | | - Larry Allen
- Division of Cardiology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Stephen J. Greene
- Duke Clinical Research Institute, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical School, Durham, NC
| | - Clyde Yancy
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Windy Alonso
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | | | - Gregg C Fonarow
- David Geffen School of Medicine at UCLA, Los Angeles, United States of America
| | | | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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Abstract
Lower lean body mass associated with reduced cardiovascular reserve at rest and peak exercise in women but not men may underlie sex differences in heart failure with preserved ejection fraction (Diaz-Canestro et al.).
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA
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