Circulation, Vol 70, 357-366, Copyright © 1984 by American Heart Association
MB Higginbotham, KG Morris, RE Coleman and FR Cobb
In previous studies from this laboratory, we found that approximately 30%
of women with chest pain and normal coronary arteries demonstrated either a
decrease in or a failure to increase radionuclide ejection fraction during
exercise. To examine the hypothesis that this apparent abnormality in left
ventricular function represents a physiologic difference between men and
women, we prospectively studied central and peripheral cardiovascular
responses to exercise in 31 age-matched healthy volunteers (16 women and 15
men). A combination of quantitative radionuclide angiography and
expired-gas analysis was used to measure ejection fraction and relative
changes in end-diastolic counts, stroke counts, count output, and
arteriovenous oxygen difference during symptom-limited upright bicycle
exercise. Normal male and female volunteers demonstrated comparable
baseline left ventricular function and similar aerobic capacity, as
determined by weight-adjusted peak oxygen consumption (22.1 +/- 5.1 and
22.6 +/- 4.3 ml/kg/min, respectively). However, their cardiac responses to
exercise were significantly different. Ejection fraction increased from
0.62 +/- 0.09 at rest to 0.77 +/- 0.07 during exercise in men (p less than
.001), but was unchanged from 0.63 +/- 0.09 at rest to 0.64 +/- 0.10 during
exercise in women. The ejection fraction increased by 5 points or more in
14 of 15 men, but in only seven of the 16 women. End-diastolic counts
increased by 30% in women (p less than .001), but was unchanged in men.
Because decreases in ejection fraction were matched by increases in
end-diastolic counts, relative increases in stroke counts and count output
were the same for men and women. These data demonstrate a basic difference
between men and women with respect to the mechanism by which they achieve a
normal response of stroke volume to exercise; these differences must be
taken into account when measurements of cardiac function during exercise
stress are used for diagnostic purposes.
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Sex-related differences in the normal cardiac response to upright exercise
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