Sex Differences in Right Ventricular, Pulmonary Vascular, and Integrated Hemodynamic Measures of Cardiac Function in HFpEF and HFrEF

Background Sex differences in clinical presentations of heart failure (HF) are pervasive, yet differences in invasive hemodynamic measures across HF subtypes remain incompletely characterized. Understanding these distinctions is critical, as sex‐specific physiology influences disease progression and prognostic assessment in HF. Methods We conducted a retrospective cohort study of 1818 patients with HF who underwent clinically indicated right heart catheterization, stratified by preserved versus reduced ejection fraction. We examined the association of sex with invasive hemodynamic measures of right ventricular, pulmonary vascular, and left ventricular function using multivariable linear regression. Results We studied n=709 individuals with heart failure with preserved ejection fraction (HFpEF) (44% women, mean age 68±10 years) and n=1109 with heart failure with reduced ejection fraction (HFrEF) (26% women, mean age 64±12 years). Women and men had similar measures of right ventricular function across HF subtypes (multivariable‐adjusted P >0.05 for all). However, 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). Women with both HFpEF and HFrEF had similar cardiac power index, but higher aortic pulsatility index ( P =0.01 for HFpEF; P <0.001 for HFrEF). Conclusions 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. Cardiac power index was similar between sexes in both HFpEF and HFrEF, whereas aortic pulsatility index was higher in women with HFrEF. Taken together, sex differences in hemodynamic measures were largely similar across individuals with HFpEF and HFrEF. Future studies are needed to delineate clinical implications of these sex differences.