Del Bene Maria Riccarda, Barletta Giuseppe, Venditti Francesco, Di Mario Carlo, Blanzola Claudio, Stefàno Pierluigi
Diagnostic Cardiology, Careggi University Hospital, Florence, Italy.
Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy.
Echocardiography. 2019 Feb;36(2):219-228. doi: 10.1111/echo.14221. Epub 2018 Dec 5.
The influence of sex on regression of left ventricular (LV) hypertrophy (LVH) after aortic valve replacement (AVR) for aortic stenosis (AS) remains elusive. The lack of consensus on how to correct LV mass (LVM) for body size, and different normalcy values, contribute to inconclusive results.
In 164 consecutive patients (mean age 80 ± 4 years, 59% females) with AS, we analyzed LVM (Devereux formula) before and 1 year after AVR (St.Jude Trifecta bio-prosthesis). LVM was indexed to BSA (Du Bois and Gehan formulas), to height and height . Limits of normalcy were (women and men, respectively): <95 and <115 g/m², BSA-indexed LVM; <60 and <81 g/m, LVM/height ; <44 and <48 g/m, LVM/height .
Women had smaller BSA, but not body mass index, than men. AS severity and incidence of hypertension did not differ. LVM indexed to height was greater in women. LVH incidence was similar in males and females. Independently of the indexation method, LVH reduced significantly (P < 0.0001). LVM reduction was greater in women (P < 0.05 for all methods). At follow-up, nearly half the patients, irrespective of sex, showed residual LVH, and diastolic dysfunction.
We tested different methods of LVM indexation in AS patients. LVM was similar between men and women. Indexation to height gives higher LVM in women because of their shorter stature. LVH prevalence is independent of sex. Irrespective of the indexation method, LVM reduction is greater in females, whereas LVM normalization occurs in equal proportion. Persistent LVH and diastolic dysfunction suggest earlier AVR in elderly.
对于因主动脉瓣狭窄（AS）行主动脉瓣置换术（AVR）后左心室（LV）肥厚（LVH）消退的性别影响仍不明确。对于如何根据体型校正左心室质量（LVM）缺乏共识，以及不同的正常范围值，导致结果尚无定论。
在164例连续的AS患者（平均年龄80±4岁，59%为女性）中，我们分析了AVR（圣犹达Trifecta生物瓣）前及术后1年的LVM（Devereux公式）。LVM根据体表面积（BSA，Du Bois和Gehan公式）、身高及身高进行指数化。正常范围分别为（女性和男性）：BSA指数化LVM<95和<115 g/m²；LVM/身高<60和<81 g/m；LVM/身高<44和<48 g/m。
女性的BSA较男性小，但体重指数无差异。AS严重程度和高血压发生率无差异。女性身高指数化的LVM更大。男性和女性的LVH发生率相似。无论指数化方法如何，LVH均显著降低（P<0.0001）。女性的LVM降低幅度更大（所有方法P<0.05）。随访时，近一半的患者，无论性别，均显示有残余LVH及舒张功能障碍。
我们在AS患者中测试了不同的LVM指数化方法。男性和女性的LVM相似。由于女性身材较矮，身高指数化的LVM更高。LVH患病率与性别无关。无论指数化方法如何，女性的LVM降低幅度更大，而LVM正常化的比例相同。持续的LVH和舒张功能障碍提示老年患者应更早行AVR。
