Abstract 16853: Adaptive Hypertrophy in Women With Aortic Valve Stenosis is Associated With Better Reversibility and Survival After Valve Replacement
Background: Women with isolated aortic valve stenosis (AS) develop more favorable LV hypertrophy (LVH) with smaller cavity size, thicker walls and less interstitial fibrosis (IF) compared with men in similar disease states. This is an important prerequisite for faster regression in women after aortic valve replacement (AVR) (Petrov et al., Circulation 2010). However it is yet uncertain whether these sex differences affect survival after AVR.
Methods: This prospective cohort study included 135 patients (mean age 70±9.6 years, 50% women) undergoing AVR for isolated AS. Echocardiography was obtained before, shortly after and 4±1.6 years after surgery. We established a longitudinal factor analytical model to study the development of LVH and its time course of regression. LV mass, LV diameters at end-diastole (LVID) and relative wall thickness (RWT) were included to generate one multidimensional factor representing the direction and the magnitude of changes in all three variables together. According to the results of the factor analysis, LVH was classified as adaptive (combining smaller LVID and LV mass and greater RWT) or maladaptive. Myocardial tissue samples from the LV septum were obtained during AVR in a subgroup of 46 patients (52% women) to analyse IF and associated key molecular regulators.
Results: Before AVR 60% of women and 24% of men had adaptive LVH and maintained this pattern after surgery (p<0.007). In contrast 50% of men and 20% of women exhibited preoperatively maladaptive LVH persisting after AVR (p<0.029). Postoperative cross-over from maladaptive to adaptive LVH patterns or vice versa occurred infrequently in both genders. In addition more IF was present in men compared to women (p<0.04). Higher TGF-β1 (p<0.01), Smad 2 phosphorylation (p<0.001) and periostin (p<0.05) levels were found in men than in women. Regarding gender and LVH pattern the post-AVR survival was significantly better in women with adaptive LVH in comparison with women with maladaptive LVH or men (p<0.01).
Conclusion: In women with AS an adaptive pattern of LVH with less myocardial fibrosis contributes to better hypertrophy reversibility and subsequent survival benefit after AVR.
- © 2013 by American Heart Association, Inc.