Chest
Volume 117, Issue 4, April 2000, Pages 1094-1099
Journal home page for Chest

Clinical Investigations
MISCELLANEOUS
Sex Differences in Left Ventricular Geometry in Aortic Stenosis: Impact on Outcome

https://doi.org/10.1378/chest.117.4.1094Get rights and content

Objective

This study of surgical aortic stenosis characterized sex differences in left ventricular (LV) geometry and outcome.

Materials and methods

We examined 92 women and 82 men who underwent echocardiography before valve replacement for aortic stenosis.

Results

Women had a smaller cavity size (LV end-diastolic diameter 48.2 ± 7 mm in women vs 53.6 ± 7.6 mm in men; p = 0.0001) and higher ejection fraction (59% in women vs 54% in men; p = 0.02). LV mass was greater in men than women (300.4 ± 88 g in men vs 250.6 ± 85.8g in women; p = 0.0055) but when corrected for body surface area, the difference was not significant. The prevalence of LV hypertrophy was similar in both sexes (51% in women vs 49% in men; p = 0.62). The 5-year survival was 82% in women and 79% in men (p = 0.9).

Conclusion

Several descriptors of LV geometry differed between men and women. These differences were largely eliminated after normalizing for body surface area. No differences in surgical mortality or long-term outcome were noted.

Section snippets

Materials and Methods

All patients undergoing aortic valve replacement for AS between 1990 and 1992 were considered for inclusion in the study. Patients were included if they met the following criteria: age > 20 years at aortic valve replacement; absence of coronary artery disease as determined by preoperative coronary angiography (threshold of 50% for the significance of a stenosis); absence of concomitant valvular heart disease requiring surgical correction; and no more than mild aortic regurgitation, as

Baseline Characteristics

Two hundred thirteen patients underwent valve replacement during the study period. Thirty-two patients underwent coronary revascularization plus aortic valve replacement, and seven patients underwent other valve replacements in addition to the aortic valve. The remaining 174 patients met all entry criteria and are the subject of this study. Ninety-two (53%) were women and 82 were men. All but one female patient (99%) responded to the follow-up questionnaire sent in December 1994. One female

Discussion

In the present series of men and women with isolated severe AS, significant differences in LV function and LV geometry were noted. The EF and cardiac index were higher in women, but the differences in LV geometry were mainly related to sex differences in body surface area. Indeed, after adjusting for body surface area, the only sex difference in LV geometry was a small but statistically significant increase in the LVEDD index in women. The cardiac index was higher in women, in keeping with the

Summary

In this large clinical series of surgical AS, there were sex differences in LV geometry, but these differences were largely related to differences in body surface area. No sex difference in outcome was observed.

ACKNOWLEDGMENT

The authors thank Sara L. Osborn Butler for help with data collection, Michelle Gayari for assistance with data analysis, and Paulette E. Schurhammer for excellent secretarial support.

References (29)

  • AM Borkon et al.

    Aortic valve selection in the elderly patient

    Ann Thorac Surg

    (1988)
  • VL Roger et al.

    Effect of Doppler echocardiography on utilization of hemodynamic cardiac catheterization in the preoperative evaluation of aortic stenosis

    Mayo Clin Proc

    (1996)
  • JD Carroll et al.

    Sex-associated differences in left ventricular function in aortic stenosis of the elderly

    Circulation

    (1992)
  • B Villari et al.

    Sex-dependent differences in left ventricular function and structure in chronic pressure overload

    Eur Heart J

    (1995)
  • Cited by (31)

    • Reduced Left Ventricular Ejection Fraction in Patients With Aortic Stenosis

      2018, Journal of the American College of Cardiology
    • Percutaneous valve therapy: Choosing the appropriate patients and outcomes

      2012, Interventional Cardiology Clinics
      Citation Excerpt :

      In contrast to these studies, the author’s group36 found significant sex differences in a population of 54 patients who underwent TAVI using the subclavian approach (33% women vs 67% men, P = .0004), because of the higher prevalence of peripheral artery disease among men. Several studies have demonstrated the existence of sex differences in the LV adaptation to AS.22,27 Women had smaller left ventricles with concentric hypertrophy and hyperdynamic LV systolic function.

    View all citing articles on Scopus
    View full text