Background

Normal values of left ventricular ejection fraction (LVEF) and absolute values of global longitudinal strain (GLS) are lower in men than in women. Data concerning the association of sex hormone levels on these left ventricular systolic function surrogates are scarce. The aim of this study was to determine the association of sex hormones with systolic left ventricular function in healthy subjects and patients with congenital adrenal hyperplasia (CAH) as a model of testosterone dysregulation.

Methods

Eighty-four adult patients with CAH (58 women; median age, 27 years; interquartile range, 23–36 years) and 84 healthy subjects matched for sex and age were prospectively included. Circulating concentrations of sex hormones were measured within 48 hours of echocardiography with assessment of LVEF and left ventricular longitudinal, radial, and circumferential strain.

Results

LVEF and GLS were higher in healthy women than in healthy men (63.9 ± 4.2% vs 60.9 ± 5.1% [P < .05] and 20.0 ± 1.9% vs 17.9 ± 2.4% [P < .001], respectively), while there was no difference in LVEF or GLS between women and men with CAH (63.9 ± 4.5% vs 63.0 ± 4.6% [P = NS] and 19.4 ± 2.2% vs 18.3 ± 1.8% [P = NS], respectively). Bioavailable testosterone levels were higher in women with CAH than in female control subjects (0.08 ng/mL [interquartile range, 0.04–0.14 ng/mL] vs 0.16 ng/mL [interquartile range, 0.04–0.3 ng/mL], P < .001) and lower in men with CAH than in male control subjects (2.3 ng/mL [interquartile range, 1.3–3 ng/mL] vs 2.9 ng/mL [interquartile range, 2.5–3.4 ng/mL], P < .05). In men, LVEF and GLS were negatively correlated with bioavailable testosterone levels (r = −0.3, P ≤ .05, and r = −0.45, P < .01, respectively), while midventricular radial strain was positively correlated with bioavailable testosterone level (r = 0.38, P < .05). The absolute value of circumferential strain was positively correlated with follicle-stimulating hormone (r = 0.65, P < .0001).

Conclusions

These data support that the existence of sex dimorphism concerning left ventricular systolic cardiac function is significantly associated with testosterone levels.

中文翻译：

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性激素在左心室收缩功能上的复杂关联：对性二态性的认识。

背景

男性的左心室射血分数（LVEF）的正常值和全球纵向应变的绝对值（GLS）低于女性。关于这些左心室收缩功能替代物的性激素水平的关联的数据很少。这项研究的目的是确定健康受试者和先天性肾上腺皮质增生（CAH）患者中性激素与收缩期左心室功能的关系，以此作为睾丸激素失调的模型。

方法

前瞻性地纳入了84名成年的CAH患者（58名女性；中位年龄为27岁；四分位间距为23-36岁）和84名性别和年龄相匹配的健康受试者。在超声心动图检查的48小时内测量了性激素的循环浓度，并评估了LVEF以及左心室的纵向，径向和圆周应变。

结果

健康女性的LVEF和GLS高于健康男性（分别为63.9±4.2％vs 60.9±5.1％[ P  <.05]和20.0±1.9％vs 17.9±2.4％[ P  <.001]），男女CAH患者的LVEF或GLS差异无统计学意义（分别为63.9±4.5％vs 63.0±4.6％[ P  = NS]和19.4±2.2％vs 18.3±1.8％[ P  = NS]）。CAH女性的生物利用睾丸激素水平高于女性对照受试者（0.08 ng / mL [四分位数范围，0.04-0.14 ng / mL] vs 0.16 ng / mL [四分位数范围，0.04-0.3 ng / mL]，P  <。 001），并且患有CAH的男性比男性对照组的男性更低（2.3 ng / mL [四分位数范围，1.3–3 ng / mL]与2.9 ng / mL [四分位数范围，2.5–3.4 ng / mL]，P <.05）。在男性中，LVEF和GLS呈负生物可利用的睾酮水平相关（[R  = -0.3，P  ≤0.05，且- [R  = -0.45，P  <0.01，分别地），而midventricular径向应变呈正生物可利用的睾酮水平有关（r  = 0.38，P  <.05）。圆周应变的绝对值与促卵泡激素呈正相关（r  = 0.65，P  <.0001）。

结论

这些数据支持有关左心收缩期心脏功能的性别差异的存在与睾丸激素水平显着相关。