Circulation, Vol 86, 1099-1107, Copyright © 1992 by American Heart Association
JD Carroll, EP Carroll, T Feldman, DM Ward, RM Lang, D McGaughey and RB Karp
BACKGROUND. In aortic stenosis, the response of the left ventricle to
pressure overload varies from compensated hypertrophy to overt heart
failure. The determinants of left ventricular adaptation are poorly
understood. METHODS AND RESULTS. Left ventricular function was compared to
assess the role of sex in 34 women and 29 men 60 years or older with both
hemodynamic and echocardiographic data characteristic of severe aortic
stenosis and no important coronary artery disease. Despite a similar degree
of left ventricular outflow obstruction in women versus men (aortic valve
area 0.54 +/- 0.20 versus 0.59 +/- 0.19 cm2, NS), the left ventricle of
women had a greater fractional shortening (37 +/- 12 versus 25 +/- 12%, p =
0.001), achieved a smaller end-systolic chamber size (1.82 +/- 0.64 versus
2.17 +/- 0.65 cm/m2, p = 0.04), and generated more pressure (210 +/- 35
versus 182 +/- 29 mm Hg, p = 0.001) with a greater maximum positive dP/dt
(2.153 +/- 794 versus 1,595 +/- 384 mm Hg/sec, p = 0.02). The men had a
lower cardiac index (2.12 +/- 0.59 versus 2.49 +/- 0.63 l/min/m2, p =
0.02), higher mean pulmonary artery pressure (35 +/- 13 versus 27 +/- 10 mm
Hg, p = 0.01), and shorter ejection period (340 +/- 40 versus 370 +/- 40
msec, p = 0.02). Women and men were equally symptomatic. Supernormal left
ventricular ejection performance was present in 41% of the women and only
14% of the men (p = 0.002). This subgroup of women had a small,
thick-walled chamber (end-diastolic radius to thickness ratio, 1.58 +/-
0.52 versus 2.45 +/- 0.51 in control women, p = 0.01) with low end-systolic
wall stress. Subnormal ejection performance was present in 64% of the men
and only 18% of the women (p = 0.002). This subgroup of men had an
increased chamber size and high end-systolic wall stress compared with
control men. Greater left ventricular mass was present in men compared with
women (211 +/- 55 versus 179 +/- 55 g/m2, p = 0.03). CONCLUSIONS. Sex is a
factor in left ventricular adaptation to valvular aortic stenosis in adults
60 years or older.
ARTICLES
Sex-associated differences in left ventricular function in aortic stenosis of the elderly
Department of Internal Medicine, University of Chicago, IL 60637.
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