1/ In the HUNT3 study, EF and GLS was highest in women, S' in men, while MAPSE showed no sex difference. The effect was present in all age groups.
pubmed.ncbi.nlm.nih.gov/29399886/
2/ Sex difference was also independent of method for GLS. But it was a simple effect of body (heart) size, while MAPSE was BSA and sex independent. folk.ntnu.no/stoylen/strain…
3/ Why is this? We also found in the HUNT study that the LV length/external diameter ratio was BSA independent, so bigger LVs were both longer AND wider. pubmed.ncbi.nlm.nih.gov/27752332/
4/ about 70% of stroke volume is due to long axis shortening. Thus, the MAPSE part of SV dominates, and = long axis shortening x mitral annular external area. With a larger diameter of a larger heart, SV is larger even with unchanged MAPSE.
5/ GLS is MAPSE corrected for LV (or wall) length, but not for diameter, so it DECREASES by increasing body and heart size, a systematic error that carries over to sex differences. MAPSE had a weak positive correlation with BSA, but not enough for significant sex differences
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