Gender related differences in the central aortic pressure waveform

After the fourth decade, women have an initial inflection on the upstroke of the aortic pressure waveform (P1) with a prominent secondary late systolic peak (P2) (type A pulse waveform). In contrast, men have a dominant initial pressure peak (P1) with an inflection (P2) on the downstroke. As a result women have a higher augmentation index, ie, difference between early and late pressure peaks divided by the pulse pressure, which is an index of pulsatile afterload. Women also have a lower subendocardial viability index, ie, the ratio of diastolic to systolic time integral, reflecting a reduction in subendocardial blood flow, largely due to a higher heart rate and shorter diastolic period.