Diagnostic Cardiology, Careggi University Hospital, Florence, Italy.
Cardiac Surgery, Careggi University Hospital, Florence, Italy.
Echocardiography. 2021 Jul;38(7):1095-1103. doi: 10.1111/echo.15122. Epub 2021 May 24.
To analyze how left ventricular (LV) remodeling and hypertrophy geometry evolve after surgical aortic valve replacement (SAVR) in octogenarian patients, and identify potential sex-related differences and implications for long-term outcomes.
In 170 patients with aortic stenosis ([AS], age 80 ± 4 years, 59% women), hypertrophy geometry and remodeling (LV index) were reanalyzed one year post-SAVR. The six-year outcomes were evaluated.
Pre-SAVR, 65% of the women and 38.6% of the men (P < .001) showed adaptive remodeling. Concentric hypertrophy was prevalent in adaptive remodeling, and mixed and dilated hypertrophy were more prevalent in maladaptive remodeling. At one year, the remodeling patterns and sex distribution were similar to those observed pre-SAVR, but the LV index decreased in women and increased in men (P < .0001). Women with adaptive remodeling had a higher incidence of persistent concentric hypertrophy with higher LV filling pressures. Long-term survival was better in women and worse in men with adaptive remodeling (P = .039). Men with adaptive remodeling and men with concentric hypertrophy had the highest risk of cardiac death. This risk was similar between sexes for patients with maladaptive remodeling and dilated hypertrophy. Women with LV ejection fraction >55% had a lower risk of cardiac death than men.
The long-term outcomes of SAVR differ between sexes in older patients with AS and adaptive LV remodeling. The LV index facilitates studying the pathways of adaptation to AS. The follow-up shifts help explain the sex differences in long-term outcomes post-SAVR. Concentric hypertrophy is associated with the highest risk of cardiac death in men.
分析 80 岁以上主动脉瓣置换术（SAVR）后左心室（LV）重构和肥大几何形状的演变，并确定潜在的性别相关差异及其对长期结果的影响。
在 170 名主动脉瓣狭窄（AS，年龄 80±4 岁，59%为女性）患者中，在 SAVR 后一年重新分析肥大几何形状和重构（LV 指数）。评估了六年的结果。
SAVR 前，65%的女性和 38.6%的男性（P<0.001）表现出适应性重构。适应性重构中存在向心性肥大，而失代偿性重构中更常见混合性和扩张性肥大。一年时，重构模式和性别分布与术前相似，但女性的 LV 指数下降，男性的 LV 指数增加（P<0.0001）。具有适应性重构的女性持续存在的向心性肥大伴更高的 LV 充盈压的发生率更高。具有适应性重构的女性长期生存率较好，而具有适应性重构的男性则较差（P=0.039）。具有适应性重构和向心性肥大的男性发生心脏死亡的风险最高。对于失代偿性重构和扩张性肥大的患者，这种风险在性别之间相似。LV 射血分数>55%的女性发生心脏死亡的风险低于男性。
在 AS 合并适应性 LV 重构的老年患者中，SAVR 的长期结果在性别之间存在差异。LV 指数有助于研究对 AS 的适应途径。随访变化有助于解释 SAVR 后长期结果的性别差异。男性中向心性肥大与心脏死亡风险最高相关。
