Transgender Women Exhibit a Distinct Stress Echocardiography Profile Compared to Age-Matched Cisgender Counterparts: The Mayo Clinic Women's Heart Clinic Experience

Fadi Adel; Connor D Walsh; John Bretzman; Philip Sang; Kyla Lara-Breitinger; Madeline Mahowald; Arvind Maheshwari; Christopher G Scott; Alexander T Lee; Caroline J Davidge-Pitts; Patricia A Pellikka; Rekha Mankad

doi:10.1016/j.echo.2024.05.004

Transgender Women Exhibit a Distinct Stress Echocardiography Profile Compared to Age-Matched Cisgender Counterparts: The Mayo Clinic Women's Heart Clinic Experience

J Am Soc Echocardiogr. 2024 May 14:S0894-7317(24)00226-8. doi: 10.1016/j.echo.2024.05.004. Online ahead of print.

Affiliations

¹ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
² University of Washington, Department of Internal Medicine, Seattle, WA.
³ Department of Radiology, Mayo Clinic, Rochester, MN.
⁴ Department of Internal Medicine, Mayo Clinic, Rochester, MN.
⁵ Division of Cardiology, Department of Medicine, University of Florida, Jacksonville, FL.
⁶ Midwest Endocrinology, Crystal Lake, IL.
⁷ Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Rochester, MN.
⁸ Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN.

PMID: 38754746
DOI: 10.1016/j.echo.2024.05.004

Abstract

Background: Stress echocardiography (SE) is an important modality in cardiovascular risk stratification and obstructive coronary artery disease (CAD) assessment. Binary sex-based parameters are classically used for interpretation of these studies, even among transgender women (TGW). CAD is a leading cause of morbidity and mortality in this population. Yet, it remains unclear whether TGW exhibit a distinct stress testing profile from their cisgender counterparts.

Methods: Using a matched case-control study design, we compared the echocardiographic stress testing profiles of TGW (n=43) with those of matched cisgender men (CGM, n=84) and cisgender women (CGW, n=86) at a single center. Relevant data, including demographics, comorbidities, and cardiac testing data were manually extracted from the patients' charts.

Results: The prevalence of hypertension and dyslipidemia was similar between TGW and CGW and lower than that of CGM (p= .003 and .009, respectively). The majority of comorbidities and lab values were similar. On average, TGW had higher heart rates than CGM (p=.002) and had lower blood pressures than CGM and CGW (p<.05). The TGW's double product and metabolic equivalents were similar to those among CGW and lower than those of CGM (p=.016, p=.018, respectively). On echocardiography, the left ventricular end-diastolic and end-systolic diameters among TGW were similar to those of CGW but lower than CGM's (p=.023, p=.018, respectively). Measures of systolic and diastolic function, except for the exercise mitral valve E:e' ratio which was lower in TGW than CGW (p=.029), were largely similar among the three groups. There was no difference in the wall motion score index, and therefore, no difference in the percentage of positive SE tests.

Conclusion: Our study shows, for the first time, that TGW have a SE profile that is distinct from that of their cisgender counterparts. Larger, multicenter, prospective studies are warranted to further characterize the SE profile of TGW.

Keywords: LGBTQIA+ Health; Stress Echocardiography; Stress Testing; Transgender Women; Women’s Health.