Gender differences in patients with severe aortic stenosis: impact on preoperative left ventricular geometry and function, as well as early postoperative morbidity and mortality

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Abstract
Objective: In patients with severe aortic stenosis, we studied the impact of gender on preoperative left ventricular geometry and function, as well as on early postoperative mortality and morbidity. Methods: Prospective Doppler echocardiographic evaluation was performed in 99 female patients and 96 males. Results: The patients had severe aortic stenosis and the mean pressure gradients were similar in females and males. Left ventricular diastolic volume adjusted for body surface area (BSA) was larger in males, 55±17.4 ml/m2 versus 43±13.1 ml/m2 (mean±standard deviation; P=0.0001). The ejection fraction was similar in females (55±14%) and males (55±13%), and patients of both sexes had significantly lower stroke volume and cardiac index than healthy controls. The relative wall thickness (wall thickness/diastolic diameter ratio) was higher (P=0.03) in females (0.47±0.10) than in males (0.43±0.10) Consequently, the diastolic diameter/wall thickness ratio (a substitute for wall tension) was higher (P=0.02) in males (4.2±0.99) than in females (3.9±0.80). Compared with survivors, patients who died within 30 days of the operation (n=17, 11 females) had a smaller body surface area (1.70±0.19 vs. 1.82±0.19 m2, P=0.012), smaller left ventricular outflow tract (20.8±0.21 vs. 22.0±0.22 mm, P=0.023), higher incidence of abnormal intraventricular flow velocity (33 vs. 8%, P=0.018) and increased relative wall thickness (0.52±0.17 vs. 0.45±0.09 P=0.039). Gender was of no independent importance for early mortality when age and left ventricular outflow tract diameter were accounted for. Conclusions: Cardiac adaptation to aortic stenosis seems to be influenced by gender, males presenting larger left ventricular volumes and higher wall tension. The echocardiographic findings of a narrow left ventricular outflow tract, abnormally increased intraventricular velocity and increased relative wall thickness identified patients with increased risk of early postoperative mortality. However gender had no independent impact on early postoperative outcome.

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