Table 1

Factors Influencing Cardiovascular Prognosis in Women and Men

WomenMen
Aging Cardiomyopathy
  • Preservation of cardiac weight

  • Preservation of myocyte number

  • Preservation of myocyte volume

  • Constant mononucleate/binucleate myocytes ratio

  • Low apoptotic index

  • Increased apoptotic rate

  • Reduction in cardiac weight (1 g/yr)

  • Reduction in myocyte number (64 million/yr)

  • Increase in myocyte cell volume

  • Decreased mononucleate/binucleate myocytes ratio

  • Apoptotic index 3-fold higher than women

  • Decreased apoptotic rate

Myocardial Response to Pressure Overload
  • Earlier improvement in EF after aortic valve replacement

Later improvement in EF after aortic valve replacement
  • Greater degree of LVH

  •  Increased LV mass

  •  Increased relative wall thickness

  •  Smaller end-diastolic and -systolic dimensions

Lower degree of LVH
Preserved LV functionImpaired LV function
  • Later onset of impaired systolic pump performance

  •  Greater EF

  •  Greater cardiac index

  •  Smaller end-diastolic and -systolic volumes

Earlier onset of impaired systolic pump performance
  • Higher expression of β-myosin heavy chain

  • Higher expression of ANF mRNA

  • Lower expression of β-myosin heavy chain

  • Higher expression of ANF mRNA

Myocardial Response to Volume Overload
  • Smaller end-diastolic and -systolic volumes

  • Greater LV mass/volume ratio

  • Concentric hypertrophy

  • No impairment of cardiac function

  • Minimal ventricular dilation

  • No changes in myocardial compliance

  • Larger end-diastolic and -systolic volumes

  • Lower LV mass/volume ratio

  • No concentric hypertrophy

  • Impairment of cardiac function

  • Significant ventricular dilation

  • Decreased ventricular compliance

Myocardial Response to Acute Myocardial Ischemia
  • Lower apoptotic rate in peri-infarct region

  • Lower baxexpression in peri-infarct region

  • Longer duration of the cardiomyopathy

  • Later onset of cardiac decompensation

  • Longer interval between heart failure and transplantation

  • Earlier myocardial healingd

  • Lower infarct expansion index

  • Three times lower mortality

  • Better cardiac function

  • Better remodeling

  • 10-fold higher apoptotic rate in peri-infarct region

  • Greater baxexpression in peri-infarct region

  • Shorter duration of the cardiomyopathy

  • Earlier onset of cardiac decompensation

  • Shorter interval between heart failure and transplantation

  • Delayed myocardial healing

  • Higher infarct expansion index

  • Greater incidence in cardiac rupture

  • Worse cardiac function

  • Maladaptive remodeling

 Significantly greater dilatation
 Myocyte hypertrophy
Premature extracellular matrix degradation
 Higher number of neutrophils
 Increased activity of metalloproteinases
Cardiogenic Shock
  • Significantly lower cardiac index

  • More frequent adverse clinical events

  • More frequent mechanical complications

  • More common low cardiac output syndrome

  • Higher cardiac index

  • Less frequent adverse clinical events

  • Less frequent mechanical complications

  • Less common low cardiac output syndrome

Heart Failure
  • Preserved LV EF

  • Smaller LV end-diastolic volume

  • Smaller stroke volumes

  • Higher LV end-diastolic pressure

  • More frequent congestive symptoms

  • Greater impairment in diastolic filling

  • Impaired LV EF

  • Greater LV end-diastolic volume

  • Greater stroke volumes

  • Lower LV end-diastolic pressure

  • Less frequent congestive symptoms

  • Lower impairment in diastolic filling

Data from animal studies are reported in italics.

ANF = atrial natriuretic factor; EF = ejection fraction; LV = left ventricle/ventricular; LVH = left ventricular hypertrophy; mRNA = messenger ribonucleic acid.