Pulmonary Arterial Hypertension and Sex in the Right Ventricle: It Is an Interesting Picture

Right ventricle (RV) function determines clinical course and longterm prognosis in patients with pulmonary arterial hypertension (PAH). Though PAH is common in females, it has been established that RV function is inferior in male patients with PAH when compared with female patients with PAH. On cardiac magnetic resonance imaging, despite having a similar degree of pulmonary vascular disease, male patients with PAH have lower RV ejection fraction than age-matched female patients with PAH. In addition, the improvement in RV function after pulmonary vasodilator therapies is less in male versus female patients with PAH. The difference in RV function response to pulmonary vasodilator therapies partially explains the survival disadvantage in male PAH patients. In fact, similar sex differences in RV function have also been documented in healthy individuals, patients with pulmonary hypertension because of left heart disease, and patients with pulmonary hypertension secondary to chronic lung disease.