Chest
Clinical InvestigationsMISCELLANEOUSSex Differences in Left Ventricular Geometry in Aortic Stenosis: Impact on Outcome
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)
- et al.
Impact of chamber geometry and gender on left ventricular systolic function in patients > 60 years of age with aortic stenosis
Am J Cardiol
(1994) - et al.
Gender-associated differences in left ventricular geometry in patients with aortic valve disease and effect of distinct overload subsets
Am J Cardiol
(1997) - et al.
Gender differences in left ventricular function at rest and with exercise in asymptomatic aortic stenosis
Am Heart J
(1996) - et al.
Determination of left ventricular ejection fraction by visual estimation during real-time two-dimensional echocardiography
Am Heart J
(1982) - et al.
Determination of left ventricular mass by echocardiography in a normal population: effect of age and sex in addition to body size
Mayo Clin Proc
(1994) - et al.
Standardization of M-mode echocardiographic left ventricular anatomic measurements
J Am Coll Cardiol
(1984) - et al.
Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: prospective Doppler-catheterization correlation in 100 patients
J Am Coll Cardiol
(1988) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases
J Clin Epidemiol
(1992) - et al.
Gender-specific reference M-mode values in adults: population-derived values with consideration of the impact of height
J Am Coll Cardiol
(1995)
Aortic valve selection in the elderly patient
Ann Thorac Surg
Effect of Doppler echocardiography on utilization of hemodynamic cardiac catheterization in the preoperative evaluation of aortic stenosis
Mayo Clin Proc
Sex-associated differences in left ventricular function in aortic stenosis of the elderly
Circulation
Sex-dependent differences in left ventricular function and structure in chronic pressure overload
Eur Heart J
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Men are from mars, women are from venus: Factors responsible for gender differences in outcomes after surgical and trans-catheter aortic valve replacement
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2018, Journal of the American College of CardiologySex, Race, and Socioeconomic Disparities in Patients With Aortic Stenosis (from a Nationwide Inpatient Sample)
2016, American Journal of CardiologyImpact of gender on three-month outcome and left ventricular remodeling after transfemoral transcatheter aortic valve implantation
2012, American Journal of CardiologyPercutaneous valve therapy: Choosing the appropriate patients and outcomes
2012, Interventional Cardiology ClinicsCitation 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.
Influence of Concentric Left Ventricular Remodeling on Early Mortality After Aortic Valve Replacement
2008, Annals of Thoracic Surgery