In clinical practice there is a tendency to consider women`s hearts different from men`s hearts regarding cardiovascular risk and diseases. It is therefore relevant to study whether there are any significant differences between the genders regarding the adaptation of the LV to the different hemodynamic patterns.
LV geometry patterns
The relation between left ventricle geometry and hemodynamic conditions has previously been studied . The LV geometrical alteration as a result of adaptation to changed hemodynamic conditions was grouped into three different hemodynamic categories.
The same geometrical categories were identified in a study by Andrén and co-workers . As many as 16% of the healthy persons demonstrated presence of left ventricle hypertrophy (mainly eccentric LV hypertrophy). LV hypertrophy was as expected more frequent in the persons suffering from hypertension or heart diseases. Despite the lower blood pressure in that study compared with the study performed by Ganau , the proportion of the normal LV geometry was lower and the proportion of persons with LVH was higher. A reasonable explanation was the higher age, longer duration of hypertension but also gender differences, as the Andrén study only included men .
In the LIFE study , a large series of middle-aged and elderly patients with moderate hypertension and target organ damage were investigated and among those who underwent echocardiography 19% had normal LV geometry, 11% concentric remodeling, 47% eccentric LV hypertrophy and 24% concentric hypertrophy. There were no significant differences among LV geometric subgroups with regard to BP, prevalence of diabetes or peripheral vascular disease. The prevalence of coronary and cardiovascular disease was almost twice as high in patients with concentric LV hypertrophy as in the other subgroups.
A subgroup study of the Framingham heart study  demonstrated that persons with concentric LVH had the worst prognosis, followed by those with eccentric hypertrophy, concentric remodeling and normal geometry. Adjustment for LV mass eliminated any association between LV geometry and outcome in women. In men however, there remained a tendency toward an increased risk for all-cause mortality in each group with abnormal LV geometry compared with the normal group.
Obesity has been associated with eccentric LVH, while hypertension has been associated with concentric LVH . Persons with concurrent obesity and hypertension presented a further increase of LVM and wall thickness above values in the merely obese or hypertensive persons and had more frequently LVH. In all these groups women had a higher frequency of abnormal LV geometry. It was suggested that the hearts of postmenopausal women respond more susceptibly to trophic stimuli. In particular concentric LVH was a common finding in women.
A study by Sveälv and co-workers in 2005 demonstrated a significant age-related decrease in end-diastolic and end-systolic volumes which was explained by shortening of the long axis length which resulted in an increased sphericity with age. This remodeling during normal aging appeared to be more pronounced in females .
Most of these studies were designed to study the hemodynamic patterns and the remodeling of the left ventricle, but whether there were gender-related differences was not investigated. One of the exceptions was the study by Krumholz and co-workers in which members of the Framingham Heart study and Framingham Offspring Study were investigated . They found that the geometric pattern of LV hypertrophy differed by sex. The subjects of this study were free of clinically apparent cardiovascular disease, not taking antihypertensive medication and without diastolic hypertension.
However we could not find such a difference between the genders in our analysis, probably depending on that our participants were elderly subjects in a general population treated with a great number of CV medications.
In the present study we investigated the genders separately and tried to reveal if there were any significant hemodynamic differences between the LV geometrical categories recognized in the earlier studies. Studying the frequency distribution of the four distinguished LV geometrical groups in men vs. women indicated no significant differences. Almost 43 percent of the men and 47 percent of the women had a normal geometry. The most common abnormal geometry was the concentric remodeling group (28% in males and 27% in females) followed by concentric and eccentric LVH.
Thus, the present study differed from Andrén's study  in 70-year old males in that concentric LVH was more common than eccentric LVH. The fact that LV mass was indexed for height in the present study and BSA in Andrén's study could hardly explain this discrepancy, since the subdivision of LVH is highly dependent of RWT, using the same cut-off limit in both studies. Since both studies were conducted in the same town in subjects with the same age and with a similar protocol, the most obvious reason for the discrepancy is that women were included in the present study. However, since no gender differences were seen between the geometric groups in the present study, other yet undiscovered differences must exist.
A significant interaction between gender and SBP was found regarding LV geometry groups. However, an increased SBP were seen in women in all LV geometric groups except the eccentric LVH group. This finding does not indicate that women have a different sensitivity to the SBP level for the development of an abnormal LV geometry, since women in the normal LV group also had an elevated systolic blood pressure.
The proportion of males and females taking antihypertensive drugs were very similar. However, the systolic blood pressure was significantly higher in woman than in men both in the group on antihypertensive treatment, as well as in the group without any treatment. Therefore, the gender difference does not seem to be due to any difference in blood pressure medication. In this age-group, SBP seems to be generally higher in women than in men. The reason for this is not known, but it is clear that this increased SBP in women is not reflected in any higher prevalence of LVH.
Evaluation of systolic function
Ganau and co-workers presented different hemodynamic patterns in the different LV geometrical categories . Concentric LVH was accompanied with an increased afterload and a normal systolic function. Eccentric LVH associated with a more spherical chamber cavity and increased diameter is a result of increased preload increasing CI. Concentric remodeling with an increased RWT, reduced LV cavity and more elliptic LV chamber shape and normal LVM was caused by an increased afterload and decreased preload resulting in a low CI. Andrén and co-workers showed the same results when measuring CI and TPRI by the Teicholz formula, but in this study the eccentric group was accompanied by a lower EF, AV-plane-displacement and a higher LV-wall motion score indicating an impaired contraction . The hemodynamic patterns in subjects with eccentric and concentric LVH were in this study more like the ones found in Andren's study compared with the study by Ganau et al.
Comparing systolic indices, such as EF and CI in men vs. women indicated a significant discrepancy between the genders regarding EF, but no significant difference in CI. However, despite these differences in EF between the genders, possibly due to an increased prevalence of MI in the males, no significant interactions were seen between gender and LV geometry groups regarding LV systolic variables.
Evaluation of diastolic function
Andrén and co-workers showed a significant prolongation of IVRT only in the eccentric LVH group and a prolongation of the deceleration time in the concentric LVH group suggesting abnormal relaxation and low LV compliance . Left atrium size was significantly enlarged in both hypertrophy groups as evidence of diastolic dysfunction. E/A-ratio indicated no significant difference between the groups with hypertrophic and normal geometry.
In the present study, the E/A-ratio was significantly lower, LA diameter increased and IVRT longer in all three abnormal categories compared with the normal group, indicating a more severe LV diastolic dysfunction in the present study as compared to the study by Andren et al.
Concerning diastolic variables we found a significant difference in LA size and IVRT, but no significance in the E/A-ratio, between men and women. However, despite this gender difference, no significant interactions were seen between gender and LV geometry regarding LV diastolic function.