Vaturi Mordehay, Weisenberg Daniel, Yedidya Idit, Shapira Yaron, Nevzorov Roman, Monakier Daniel, Sagie Alex
The Dan Sheingarten Echocardiography Unit and Valvular Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
J Heart Valve Dis. 2012 Jan;21(1):31-6.
Patient gender can affect not only the clinical manifestations of coronary artery disease (CAD) but also the clinician's interpretation of the symptoms and results of exercise stress tests for management decisions. This may be true also for aortic stenosis (AS), given its many shared features with CAD and similar symptom-based management. The study aim was to evaluate the effect of gender on the assessment of severe asymptomatic AS by exercise stress echocardiography (ESE).
A total of 160 patients (89 males, 71 females) with severe asymptomatic AS and good left ventricular function underwent ESE for assessment of their clinical status. Of these patients, 133 (83%) were followed up after echocardiography for a mean of 644 +/- 467 days. The findings and outcome were compared between males and females.
No gender-related differences were identified for mean age, baseline and peak exercise heart rates and blood pressures, aortic valve area, and prevalence of CAD. Female patients had a lower exercise capacity (shorter exercise time, lower exercise load), but there were no significant between-group differences in the exercise-related parameters defining AS. In total, 38 women (24%) and 45 men (28%) were treated by aortic valve replacement (p = 0.2) within a similar time range from echocardiography (p = 0.6).
Asymptomatic women with severe AS have similar rates of abnormal ESE as men, despite limitations in exercise capacity among women compared to men.
患者性别不仅会影响冠状动脉疾病（CAD）的临床表现，还会影响临床医生对症状的解读以及运动负荷试验结果，进而影响治疗决策。鉴于主动脉瓣狭窄（AS）与CAD有许多共同特征且症状管理相似，性别对其可能也有类似影响。本研究旨在评估性别对运动负荷超声心动图（ESE）评估重度无症状AS的影响。
共有160例重度无症状AS且左心室功能良好的患者（89例男性，71例女性）接受ESE以评估其临床状况。其中133例（83%）患者在超声心动图检查后进行了随访，平均随访时间为644±467天。比较了男性和女性的检查结果及预后情况。
在平均年龄、基线和运动峰值心率及血压、主动脉瓣面积和CAD患病率方面，未发现性别差异。女性患者运动能力较低（运动时间较短，运动负荷较低），但在定义AS的运动相关参数方面，两组之间无显著差异。在超声心动图检查后的相似时间范围内（p = 0.6），共有38例女性（24%）和45例男性（28%）接受了主动脉瓣置换术（p = 0.2）。
重度无症状AS的女性患者与男性患者的ESE异常率相似，尽管女性的运动能力与男性相比存在局限性。
