Saeed Sahrai, Dweck Marc R, Chambers John
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Expert Rev Cardiovasc Ther. 2020 Feb;18(2):65-76. doi: 10.1080/14779072.2020.1732209.
: In aortic stenosis (AS), there are clear sex differences in clinical presentation, left ventricular (LV) response to pressure overload, and pathophysiology of valvular calcification. These differences may affect outcome following valve intervention.: This review aims to discuss sex differences in clinical presentation, pathophysiology of aortic valve calcification, LV remodeling in view of historic and recent echocardiographic and cardiac magnetic resonance imaging studies, and outcome after valve intervention. In addition, it will also provide some brief insights on the exercise physiology in women and men with AS.: Women at presentation are often older, have higher prevalence of hypertension and diastolic dysfunction, while men are younger, and more often have a bicuspid aortic valve and higher atherosclerotic disease burden. Men have more valve calcification than women for a given severity of AS and develop different patterns of LV remodeling and myocardial fibrosis. Although women tend to walk shorter on treadmill and achieve lower metabolic equivalents, they achieve similar peak heart rates and blood pressure, and the frequency of revealed symptoms during exercise test is comparable in both sexes. Men are more likely to undergo a surgical AVR with better outcome, while women have generally better outcome after TAVI.
在主动脉瓣狭窄（AS）中，临床表现、左心室（LV）对压力超负荷的反应以及瓣膜钙化的病理生理学方面存在明显的性别差异。这些差异可能会影响瓣膜干预后的结果。本综述旨在根据历史和近期的超声心动图及心脏磁共振成像研究，探讨临床表现、主动脉瓣钙化的病理生理学、LV重塑方面的性别差异，以及瓣膜干预后的结果。此外，还将对患有AS的女性和男性的运动生理学提供一些简要见解。就诊时女性往往年龄较大，高血压和舒张功能障碍的患病率较高，而男性则较年轻，更常患有二叶式主动脉瓣且动脉粥样硬化疾病负担较重。对于给定严重程度的AS，男性的瓣膜钙化比女性更多，并且会出现不同类型的LV重塑和心肌纤维化。尽管女性在跑步机上行走的距离往往较短，达到的代谢当量较低，但她们达到的峰值心率和血压相似，并且运动试验期间出现症状的频率在两性中相当。男性更有可能接受外科主动脉瓣置换术（AVR）且结果较好，而女性经导管主动脉瓣置入术（TAVI）后的总体结果通常较好。
