Abstract 15033: Gender Differences in the Impact of Left Ventricular Remodeling Patterns on Outcomes in Aortic Stenosis
BACKGROUND: LV hypertrophy has been linked to LV dysfunction, cardiac events and higher operative risk in patients with aortic stenosis (AS). However, little is known about the impact of the LV remodeling patterns on outcomes of AS patients. The aims of this study were to examine prognostic value of LV remodeling pattern on mortality in AS population and to assess potential interaction with gender.
METHODS: 747 patients (69±14 y.o.; 57% men) with AS (52% severe) and preserved LV ejection fraction were included. According to LV mass index and relative wall thickness, patients were classified into 4 LV patterns: normal, concentric remodeling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH).
RESULTS: 128 (17%) had normal pattern, 157 (21%) had CR, 382 (51%) had CH and 80 (11%) had EH. During a mean follow-up of 5.9±3.8 yrs, 339 patients died, including 242 from CV causes. Ten-year survival rates were 38% in patients with CH compared to 49% in CR, 53% in EH, and 61% in patients with normal pattern (p<0.001). In multivariable analysis adjusted for age, gender, hypertension, CAD, diabetes, kidney failure, and AS severity, there was a trend (p=0.09) for association between CH and increased mortality. There was an interaction (p=0.08) between LV pattern and gender with respect to the impact on mortality: i.e. CH was associated with worse outcome in women (HR= 2.12; p<0.001, figure) but not in men (HR=1.20; p=0.21). After same adjustment, CH pattern (HR=1.48, p=0.04) was an independent predictor of mortality in women. Further adjustment for aortic valve replacement or analysis of cardiovascular mortality provided similar results.
CONCLUSION: This study reports that LV concentric hypertrophy is associated with increased mortality in women with AS but not in men. Hence, besides the assessment of LV mass and hypertrophy, the type of LV pattern should also be taken into consideration for the risk stratification of patients with AS, and particularly of women.
- © 2013 by American Heart Association, Inc.