Background Whilst females have relatively greater preservation of left ventricular ejection fraction (LVEF) following myocardial infarction (MI), they have higher rates of heart failure, presumably due to diastolic dysfunction (DD). This study sought to assess sex differences in LV diastolic function on Doppler echocardiography following MI.

Methods Data on 2505 consecutive patients with a first-ever MI (defined using the Universal Definition of MI) between 2013 and 2020 were included. Echocardiography was performed within 24 h of admission. Significant DD was defined as grade 2 + 3 DD according to current ASE/EACVI guidelines. Diastolic function score (DFS) was calculated by summing the number of abnormal parameters out of the four key diastolic parameters (e′ velocity, E/e′ ratio, left atrial volume index [LAVI], and tricuspid regurgitation velocity [TRV]).

Results Compared to males, females were older, had greater co-morbidity, less 3-vessel disease, higher LVEF (55.0 + 9.8% vs. 52.7 ± 9.8%, p < 0.001), and a greater proportion with LVEF > 50% (74.4% vs. 66.2%, p < 0.001). On group comparisons between sexes, LAVI, e′ velocity, E/e′ ratio, significant DD, and DFS showed greater abnormalities in females. In multivariable models incorporating clinical, angiographic and echocardiographic data to determine independent predictors of diastolic parameters, female sex was independently associated with abnormal LAVI (OR 1.40, p = 0.017), E/e′ ratio (OR 2.86, p < 0.001), TRV (OR 1.88, p = 0.004), significant DD (OR 2.12, p < 0.001) and DFS (OR 2.59, p < 0.001).

Conclusions Female sex is a strong independent predictor of DD on Doppler echocardiography in patients with a first-ever MI. This may explain the higher incidence of heart failure despite relatively preserved LVEF in females following MI.