SEX-ASSOCIATED DIFFERENCES IN LEFT-VENTRICULAR FUNCTION IN AORTIC-STENOSIS OF THE ELDERLY
SEX-ASSOCIATED DIFFERENCES IN LEFT-VENTRICULAR FUNCTION IN AORTIC-STENOSIS OF THE ELDERLY
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DOI：
10.1161/01.cir.86.4.1099
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发表时间：
1992-10-01
期刊：
影响因子：
37.8
通讯作者：
KARP, RB
中科院分区：
文献类型：
--
作者：
CARROLL, JD;CARROLL, EP;KARP, RB
背景在主动脉瓣狭窄中，左心室对压力超负荷的反应从代偿性肥大到明显的心力衰竭不等。左心室适应性的决定因素知之甚少。方法和结果。比较34名女性和29名男性60岁或以上患者的左心室功能，以评估性别的作用，这些患者的血流动力学和超声心动图数据均为严重主动脉瓣狭窄的特征，无重要的冠状动脉疾病。尽管女性和男性的左心室流出道梗阻程度相似（主动脉瓣面积0.54+/-0.20vs0.59 +/-0.19cm2，NS），女性左心室缩短率更大（37+/-12 vs 25+/-12%，p=0.001），实现了更小的收缩末期腔室尺寸（1.82+/-0.64 vs. 2.17+/-0.65 cm/m2，p=0.04），并产生更多压力（210+/-35 vs 182+/-29 mm Hg，p=0.001），最大正dP/dt更大（2，153 +/-794 vs 1，595 +/-384 mm Hg/sec，p=0.02）。男性心脏指数较低（2.12+/-0.59 vs 2.49+/-0.63 l/min/m2，p=0.02），平均肺动脉压较高（35+/-13 vs 27+/-10 mm Hg，p=0.01），射血期较短（340+/-40 vs 370+/-40 msec，p=0.02）。女性和男性的症状相同。41%的女性和14%的男性存在超常的左心室射血功能（p=0.002）。这组女性有一个小而厚壁的腔室（舒张末期半径与厚度之比为1.58+/-0.52，对照组为2.45+/-0.51，p=0.01），收缩末期室壁应力较低。64%的男性和18%的女性存在射血功能低于正常的情况（p=0.002）。与对照组相比，这一亚组男性的心腔尺寸增加，收缩末期室壁应力升高。与女性相比，男性的左心室质量更大（211+/-55vs179 +/-55g/m2，p=0.03）。性别是60岁或以上成人左心室适应主动脉瓣狭窄的一个因素。
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.