Bella Jonathan N, Palmieri Vittorio, Roman Mary J, Paranicas Mary F, Welty Thomas K, Lee Elisa T, Fabsitz Richard R, Howard Barbara V, Devereux Richard B
Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, New York, USA.
Am J Cardiol. 2006 Sep 15;98(6):834-7. doi: 10.1016/j.amjcard.2006.03.069. Epub 2006 Aug 7.
Data from population-based studies indicate that men have a higher incidence and worse prognoses of congestive heart failure than women. Echocardiography was used to compare left ventricular (LV) myocardial and chamber contractility between 490 male and 861 female American Indian participants in the second Strong Heart Study examination. After adjusting for fat-free mass, baseline hypertension, diabetes mellitus, coronary heart disease, and alcohol consumption, LV ejection fractions were higher in women than men (66 +/- 8% vs 63 +/- 9%, p = 0.002), as were stress-corrected mid-wall shortening (106 +/- 13% vs 104+/-15%, p = 0.006) and the circumferential end-systolic stress/end-systolic volume index (7.1 x 10(4) +/- 1.9 x 10(4) vs 6.5 x 10(4) +/- 2.1 x 10(4) kdyne/cm3, all p values <0.001). LV ejection fractions were less than the predefined partition value in 4.7% of women and in 16.7% of men (odds ratio 0.25, 95% confidence interval 0.18 to 0.34, p <0.001). Stress-corrected mid-wall shortening was less than the predetermined lower limit of normal in 2.9% of women and in 6.2% of men (odds ratio 0.45, 95% confidence interval 0.29 to 0.70, p <0.001). There was no significant gender difference in supranormal function by either measure of LV systolic function. Estimated mean independent effects of female gender were a 3% greater ejection fraction, 2.7% greater stress-corrected mid-wall shortening, and a 0.4 x 10(4) kdyne/cm3 greater circumferential end-systolic stress/end-systolic volume index. In conclusion, in a population-based sample aged 45 to 74 years, women had greater LV myocardial and chamber function than men. Gender-specific partition values for measures of LV systolic function may be necessary to detect abnormal contractility in clinical and epidemiologic studies.
基于人群的研究数据表明，男性充血性心力衰竭的发病率高于女性，且预后更差。在第二次强心脏研究检查中，利用超声心动图比较了490名美国印第安男性参与者和861名美国印第安女性参与者的左心室（LV）心肌及心腔收缩功能。在对去脂体重、基线高血压、糖尿病、冠心病和酒精摄入量进行校正后，女性的左心室射血分数高于男性（66±8%对63±9%，p = 0.002），压力校正后的室壁中层缩短率（106±13%对104±15%，p = 0.006）以及圆周收缩末期应力/收缩末期容积指数（7.1×10⁴±1.9×10⁴对6.5×10⁴±2.1×10⁴ kdyne/cm³，所有p值均<0.001）也是如此。4.7%的女性和16.7%的男性左心室射血分数低于预定义的划分值（比值比0.25，95%置信区间0.18至0.34，p<0.001）。2.9%的女性和6.2%的男性压力校正后的室壁中层缩短率低于正常下限（比值比0.45，95%置信区间0.29至0.70，p<0.001）。通过任何一种左心室收缩功能测量方法，超正常功能在性别上均无显著差异。女性性别估计的平均独立效应为射血分数高3%，压力校正后的室壁中层缩短率高2.7%，圆周收缩末期应力/收缩末期容积指数高0.4×10⁴ kdyne/cm³。总之，在年龄为45至74岁的基于人群的样本中，女性的左心室心肌和心腔功能优于男性。在临床和流行病学研究中，可能需要针对左心室收缩功能测量的性别特异性划分值来检测异常收缩功能。
